Macrovascular Disease And Diabetes An Overview

Both type 1 and type 2 diabetes are powerful and independent risk factors for coronary artery disease (CAD), stroke, and peripheral artery disease. More specifically, the Framingham study showed that type 2 diabetes is associated with approximately a twofold increase in CAD in men and a fourfold increase in women (41). It is also known that patients with diabetes have the same risk of acute myocardial infarction than patients without diabetes with a history of previous myocardial infarction, thus all patients with diabetes have to be considered in secondary prevention for CAD (42). Mortality from CAD in individuals with diabetes is also higher than in subjects without diabetes (43).

As opposed to the clear influence of hyperglycemia in the development of microvas-cular complications in diabetes, hyperglycemia plays a less strong role in the development of macrovascular disease, in particular CAD, as shown by the UKPDS (10). Thus, the risk for macrovascular disease in diabetes seems to rely to a considerable degree on other associated abnormalities, such as hypertension, dyslipidemia, altered fibrinolysis, and obesity, all components of the insulin resistance syndrome (44). Endothelial dysfunction/activation, detected in most of the clinical abnormalities associated to the insulin resistance syndrome, is now considered a precocious event in the clinical history of both micro- and macrovascular complications, contributing to the initiation and progression of the vascular damage in diabetes.

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