Vitamin E and cardiovascular protection in diabetes

Atheromatous vascular disease is responsible for 70% of deaths in patients with diabetes and a twofold to fourfold excess mortality in those with impaired glucose tolerance.1 Although diabetes is an independent risk factor for cardiovascular disease, some excess risk may also be related to the association of diabetes with other risk factors, including hyperlipidaemia and hypertension in the “metabolic syndrome.” However, treating these risk factors is unlikely to have a major impact on cardiovascular complications associated with diabetes.2 New approaches to reducing cardiovascular risk in diabetes need to be assessed. Increased awareness of the role of oxidative stress in the pathogenesis of atheroma3 has opened new avenues for research. One peroxidation product, oxidised low density lipoprotein (ox-LDL), damages the vascular endothelium and is potently atherogenic. It impairs endothelium dependent relaxation, which is mediated by nitric oxide, an endogenous vasodilator with antiatherogenic properties. Impaired endothelium dependent relaxation may be a …