Circulation. 2003;108:1527-1532
doi: 10.1161/01.CIR.0000091257.27563.32
doi: 10.1161/01.CIR.0000091257.27563.32
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(Circulation. 2003;108:1527.)
© 2003 American Heart Association, Inc.
Review: Clinical Cardiology: New Frontiers |
Diabetes and Vascular Disease
Pathophysiology, Clinical Consequences, and Medical Therapy: Part I
From the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (M.A.C., J.A.B.); Cardiology, CardioVascular Center, University Hospital and Cardiovascular Research, Institute of Physiology, University Zürich, Switzerland (T.F.L., F.C.); and Cardiology, II Faculty of Medicine, University "La Sapienza", Rome & IRCCS Neuromed, Pozzilli, Italy (F.C.).
Correspondence to Mark A. Creager, MD, Brigham and Women’s Hospital, Cardiovascular Division, 75 Francis St, Boston, MA 02115. E-mail mcreager@partners.org
Key Words: diabetes mellitus • cardiovascular diseases • nitric oxide • atherosclerosis • insulin
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Introduction |
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Diabetes mellitus affects approximately 100 million persons worldwide.1 Five to ten percent have type 1 (formerly known as insulin-dependent) and 90% to 95% have type 2 (non–insulin-dependent) diabetes mellitus. It is likely that the incidence of type 2 diabetes will rise as a consequence of lifestyle patterns contributing to obesity.2 Cardiovascular physicians are encountering many of these patients because vascular diseases are the principal causes of death and disability in people with diabetes. The macrovascular manifestations include atherosclerosis and medial calcification. The microvascular consequences, retinopathy and nephropathy, are major causes of blindness and end-stage renal failure. Physicians must be cognizant of the salient features of diabetic vascular disease in order to treat these patients most effectively. The present review will focus on the relationship of diabetes mellitus and atherosclerotic vascular disease, highlighting pathophysiology and molecular mechanisms (Part I) and clinical manifestations and management strategies (Part II).
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Pathophysiology of Diabetic Vascular Disease |
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Abnormalities in endothelial and vascular smooth muscle cell function, as well as a propensity to thrombosis, contribute to atherosclerosis and its complications. Endothelial cells, because of their strategic anatomic position between the circulating blood and the vessel wall, regulate vascular function and structure. In normal endothelial cells, biologically active substances are synthesized and released to maintain vascular homeostasis, ensuring adequate blood flow and nutrient delivery while preventing thrombosis and leukocyte diapedesis.3 Among the important molecules synthesized by the endothelial cell is nitric oxide (NO), which is constitutively produced by endothelial NO synthase (eNOS) through a 5-electron oxidation of the guanidine-nitrogen terminal of L-arginine.4
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J. Molnar, S. Yu, N. Mzhavia, C. Pau, I. Chereshnev, and H. M. Dansky Diabetes Induces Endothelial Dysfunction but Does Not Increase Neointimal Formation in High-Fat Diet Fed C57BL/6J Mice Circ. Res., June 10, 2005; 96(11): 1178 - 1184. [Abstract] [Full Text] [PDF]
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M. S. O'Neill, A. Veves, A. Zanobetti, J. A. Sarnat, D. R. Gold, P. A. Economides, E. S. Horton, and J. Schwartz Diabetes Enhances Vulnerability to Particulate Air Pollution-Associated Impairment in Vascular Reactivity and Endothelial Function Circulation, June 7, 2005; 111(22): 2913 - 2920. [Abstract] [Full Text] [PDF]
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J. O. Prior, M. J. Quinones, M. Hernandez-Pampaloni, A. D. Facta, T. H. Schindler, J. W. Sayre, W. A. Hsueh, and H. R. Schelbert Coronary Circulatory Dysfunction in Insulin Resistance, Impaired Glucose Tolerance, and Type 2 Diabetes Mellitus Circulation, May 10, 2005; 111(18): 2291 - 2298. [Abstract] [Full Text] [PDF]
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Z. T. Bloomgarden The European Association for the Study of Diabetes Diabetes Care, May 1, 2005; 28(5): 1250 - 1257. [Full Text] [PDF]
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J. D. Flaherty and C. J. Davidson Diabetes and Coronary Revascularization JAMA, March 23, 2005; 293(12): 1501 - 1508. [Abstract] [Full Text] [PDF]
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K. V. Ramana, B. Friedrich, R. Tammali, M. B. West, A. Bhatnagar, and S. K. Srivastava Requirement of Aldose Reductase for the Hyperglycemic Activation of Protein Kinase C and Formation of Diacylglycerol in Vascular Smooth Muscle Cells Diabetes, March 1, 2005; 54(3): 818 - 829. [Abstract] [Full Text] [PDF]
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M. L. Sheu, F. M. Ho, R. S. Yang, K. F. Chao, W. W. Lin, S. Y. Lin-Shiau, and S.-H. Liu High Glucose Induces Human Endothelial Cell Apoptosis Through a Phosphoinositide 3-Kinase-Regulated Cyclooxygenase-2 Pathway Arterioscler Thromb Vasc Biol, March 1, 2005; 25(3): 539 - 545. [Abstract] [Full Text] [PDF]
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A. V. Finn, I. F. Palacios, A. Kastrati, and H. K. Gold Drug-eluting stents for diabetes mellitus: A rush to judgment? J. Am. Coll. Cardiol., February 15, 2005; 45(4): 479 - 483. [Abstract] [Full Text] [PDF]
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A. Prasad, G. W. Stone, T. D. Stuckey, C. O. Costantini, P. J. Zimetbaum, M. McLaughlin, R. Mehran, E. Garcia, J. E. Tcheng, D. A. Cox, et al. Impact of diabetes mellitus on myocardial perfusion after primary angioplasty in patients with acute myocardial infarction J. Am. Coll. Cardiol., February 15, 2005; 45(4): 508 - 514. [Abstract] [Full Text] [PDF]
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A. Tajaddini, D. L. Kilpatrick, P. Schoenhagen, E. M. Tuzcu, M. Lieber, and D. G. Vince Impact of age and hyperglycemia on the mechanical behavior of intact human coronary arteries: an ex vivo intravascular ultrasound study Am J Physiol Heart Circ Physiol, January 1, 2005; 288(1): H250 - H255. [Abstract] [Full Text] [PDF]
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P. R. Moreno and V. Fuster New aspects in the pathogenesis of diabetic atherothrombosis J. Am. Coll. Cardiol., December 21, 2004; 44(12): 2293 - 2300. [Abstract] [Full Text] [PDF]
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K. K. Koh, M. J. Quon, S. H. Han, W.-J. Chung, J. Y. Ahn, Y.-H. Seo, M. H. Kang, T. H. Ahn, I. S. Choi, and E. K. Shin Additive Beneficial Effects of Losartan Combined With Simvastatin in the Treatment of Hypercholesterolemic, Hypertensive Patients Circulation, December 14, 2004; 110(24): 3687 - 3692. [Abstract] [Full Text] [PDF]
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D. J Collinson, R. Rea, and R. Donnelly Masterclass series in peripheral arterial disease: Vascular risk: diabetes Vascular Medicine, November 1, 2004; 9(4): 307 - 310. [PDF]
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T. Hamanishi, H. Furuta, H. Kato, A. Doi, M. Tamai, H. Shimomura, S. Sakagashira, M. Nishi, H. Sasaki, T. Sanke, et al. Functional Variants in the Glutathione Peroxidase-1 (GPx-1) Gene Are Associated With Increased Intima-Media Thickness of Carotid Arteries and Risk of Macrovascular Diseases in Japanese Type 2 Diabetic Patients Diabetes, September 1, 2004; 53(9): 2455 - 2460. [Abstract] [Full Text] [PDF]
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A. Kouroedov, M. Eto, H. Joch, M. Volpe, T. F. Luscher, and F. Cosentino Selective Inhibition of Protein Kinase C{beta}2 Prevents Acute Effects of High Glucose on Vascular Cell Adhesion Molecule-1 Expression in Human Endothelial Cells Circulation, July 6, 2004; 110(1): 91 - 96. [Abstract] [Full Text] [PDF]
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G. E. Sonnenberg, G. R. Krakower, L. J. Martin, M. Olivier, A. E. Kwitek, A. G. Comuzzie, J. Blangero, and A. H. Kissebah Genetic determinants of obesity-related lipid traits J. Lipid Res., April 1, 2004; 45(4): 610 - 615. [Abstract] [Full Text] [PDF]
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S. V. Brodsky, O. Gealekman, J. Chen, F. Zhang, N. Togashi, M. Crabtree, S. S. Gross, A. Nasjletti, and M. S. Goligorsky Prevention and Reversal of Premature Endothelial Cell Senescence and Vasculopathy in Obesity-Induced Diabetes by Ebselen Circ. Res., February 20, 2004; 94(3): 377 - 384. [Abstract] [Full Text] [PDF]
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M. Zeller, Y. Cottin, M.-C. Brindisi, G. Dentan, Y. Laurent, L. Janin-Manificat, I. L'Huillier, J.-C. Beer, C. Touzery, H. Makki, et al. Impaired fasting glucose and cardiogenic shock in patients with acute myocardial infarction Eur. Heart J., February 2, 2004; 25(4): 308 - 312. [Abstract] [Full Text] [PDF]
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M. Roffi and E. J. Topol Percutaneous coronary intervention in diabetic patients with non-ST-segment elevation acute coronary syndromes Eur. Heart J., February 1, 2004; 25(3): 190 - 198. [Abstract] [Full Text] [PDF]
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P. C. Deedwania Metabolic Syndrome and Vascular Disease: Is Nature or Nurture Leading the New Epidemic of Cardiovascular Disease? Circulation, January 6, 2004; 109(1): 2 - 4. [Full Text] [PDF]
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T. F. Luscher, M. A. Creager, J. A. Beckman, and F. Cosentino Diabetes and Vascular Disease: Pathophysiology, Clinical Consequences, and Medical Therapy: Part II Circulation, September 30, 2003; 108(13): 1655 - 1661. [Full Text] [PDF]
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