Vascular Effects of Diabetes Mellitus

Diabetes mellitus (DM) is one of the most potent independent risk factors for the development of coronary ar- tery disease (CAD) and is recognized as a cardiovascular disease equivalent. Compared with individuals without DM, those with DM have a higher prevalence of CAD, a greater extent of coronary ischemia, and are more likely to have a myocardial infarction and silent myocardial ischemia. The vasculature of diabetic patients is more vulnerable in develop- ing atherosclerotic plaques in comparison with the vasculature of the non diabetic individuals. Microvascular and mac- rovascular effects are observed in the majority of organs of diabetic patients. Endothelial dysfunction, increased stiffness of the aorta, renal artery stenosis, diabetic nephropathy, carotid artery stenosis leading to cerebrovascular insufficiency, CAD and heart failure are the main complications of DM on the vasculature. Therapeutic modalities such as angiotensin- converting enzyme inhibitors, angiotensin II receptor blockers, thiazolidinediones (glitazones), statins, and antioxidants may be useful in these patients.