Epidemiology and risk factors of macrovascular disease in diabetes mellitus.

Cardiovascular diseases are the major cause of morbidity and mortality in the diabetic patient. The acceleration of atherogenesis occurs in all types of diabetes and culminates in such fatal complications as myocardial infarction, stroke and gangrene. Subjects with non-insulin-dependent diabetes mellitus exhibit a 3-4 times higher rate of cardiovascular mortality than non-diabetic persons. Since it was not possible to explain the excess risk by the traditional cardiovascular risk factors, various hypothesis have been put forward. These include certain aspects of blood pressure elevation, lipid changes, hyperinsulinemia, abnormal hemostasis, and impaired kidney function.