Diabetes mellitus: Alterations in vessel wall properties

Abstract

Diabetes is an increasing major health problem worldwide. One of its characteristic manifestations is vascular disease. There are two different types of vascular disease in diabetes, one affecting small resistance arteries, arterioles, and capillaries (microvascular disease) and the other affecting large conductance vessels (macrovascular disease). Indeed, diabetes-induced vascular complications are the major cause of morbidity and mortality in these subjects and provoke considerable amount of disability, premature mortality, loss of productivity, and increased demands on health-care facilities. While hyperglycemia is a key factor for microvascular complications development, it is only one of the multiple factors capable of increasing the risk of atherosclerotic macrovascular disease in diabetes. Given the impact of diabetic vascular disease, great effort has been directed towards reducing vascular outcomes in diabetes. While a better glucose control has a doubtless beneficial effect in reducing microvascular disease, its role in improving macrovascular outcomes is yet controversial. This chapter will mainly discuss aspects of pathophysiology and pathogenesis involved in the development of vascular disease in diabetes, as well as the diagnosis of vascular disease and current therapy.