All major pathophysiological pathways leading to accelerated atherothrombosis are disturbed in patients with type 2 diabetes. However, to prove that a risk factor is contributing to a higher risk of cardiovascular disease in patients with type 2 diabetes, two conditions must be fulfilled. First, a potential risk factor has to be associated with cardiovascular risk in longitudinal studies. Secondly, evidence from trials is needed to demonstrate that normalisation of a risk factor reduces the cardiovascular event rate. Many potential risk factors from atherothrombosis in patients with type 2 diabetes have been studied in a cross-sectional setting. With respect to endothelial function, previous studies have shown that subjects with insulin resistance or type 2 diabetes have an impairment in their ability to increase blood flow to peripheral insulin-sensitive tissues, at least partly due to their inability to induce NO-mediated vasodilatation (Creager etal., 2003). However, endothelial dysfunction is difficult to measure in large population-based studies, and therefore prospective studies on type 2 diabetic patients are missing.
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