Diabetes and cardiovascular disease: explaining the relationship.

Diabetes is a risk factor for cardiovascular disease. However, even elevated glucose levels below the diabetic range increase cardiovascular risk. There are several possible explanations for this relationship. First, glucose and its metabolites have direct toxic effects on vascular endothelium. Second, abnormal glucose is evidence of absolute or relative insulin deficiency, which can predispose patients to cardiovascular disease via endothelial dysfunction, lipid abnormalities, and inflammation. Third, antecedent factors, such as toxins, abnormal energy storage, and hypertension, may contribute to the development of both diabetes and cardiovascular disease. Whether glucose lowering can reduce the risk of cardiovascular disease is currently being studied in a number of large trials.