Diabetes and macrovascular disease.

Cardiovascular disease (CVD) is the major cause of morbidity and mortality in patients with diabetes. Macrovascular events, including stroke, myocardial infarction (MI), and peripheral arterial disease (PAD), occur earlier than in nondiabetics and the underlying pathologies are often more diffuse and severe. Diabetic arteriopathy, which encompasses endothelial dysfunction, hypercoagulability, changes in blood flow, and platelet abnormalities, contributes to the early evolution of these events. Tight glucose and blood pressure control improves the vascular status of these patients by varying degrees. Antiplatelet agents have also been shown to be effective in the secondary prevention of cardiovascular events. In the ideal world, every risk factor would be addressed and each diabetic would have excellent glycemic control, a low normal blood pressure, a low LDL, and be prescribed an ACE inhibitor, together with aspirin and clopidogrel. If this is done, this emerging epidemic of macrovascular disease will be contained.