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Atherosclerosis a leading cause of complications among diabetics:AACC:"At the present time, what are the two most common causes of death in type 1 diabetes? Ischemic heart disease (IHD) from coronary artery disease (CAD) Renal failure. CAD usually results from atherosclerosis. Atherosclerosis is the process in which intimal thickening leads to blood vessel obstruction of the medium and large arteries. When cholesterol is deposited in the intima and macrophages and smooth muscle cells proliferate, an atheromatous plaque is formed. The precursor of the plaque is the fatty streak. The atheromatous plaque bulges into the lumen of the artery, decreasing the cross-sectional diameter of the artery. Over time, calcium can be deposited in the plaques.Other names for the atheromatous plaque include fibrous, fibrofatty, lipid, and fibrolipid plaque. The endothelium covering the plaque may be stripped off or may ulcerate. A fibrous cap covering the necrotic core is present in a fully developed plaque. The fibrous cap consists of smooth muscle cells, macrophages, foam cells, lymphocytes, collagen, elastin, and proteoglycans. If this cap is disrupted, platelets can acutely become deposited on the cap, causing acute blood vessel obstruction and myocardial infarction or stroke."
http://www.aacc.org/symposia/ada/img/4.htm

Diabetic Vascular Complications Explained:Penny Stern, MD Proceedings of the National Academy of Sciences:"The complex mechanism by which diabetes wreaks its devastating damage on the blood vessels of the human body is now closer to being understood, according to a new report. The findings may lead to new ways to study and to treat the arterial disease common in diabetic patients, including poor circulation and heart disease. Dr. Jose Halperin and colleagues at the Harvard Medical School, the Brigham and Women's Hospital and the Joslin Diabetes Center, all in Boston, Massachusetts, examined whether a blood component called complement, can account for the vascular problems seen in diabetics. Complement is involved in destroying foreign cells and particles as part of the immune response. The team's results are published in the May 9th issue of the Proceedings of the National Academy of Sciences."
contact the podiatry channel
http://www.podiatrychannel.com/PodiatryWorld/vascular.shtml

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Coronary atherosclerosis and mortality in type 2 diabetes:medforum:"Diabetes, especially type 2, is associated with a markedly increased risk of morbidity related to cardiovascular disease in general and coronary atherosclerosis in particular. Mechanisms by which diabetes leads to this increase in mortality remain unclear, and evidence linking the prognosis of diabetic patients with the extent of coronary atherosclerosis has been conflicting [1, 2]. The study by Natali et al. is an important contribution to our knowledge in this field because it provides some evidence of a linkage between diabetes, extensive coronary lesions and prognosis.The concept that diabetes is associated with more severe atherosclerosis is supported by clinical and angiographic observations: diabetic patients have a smaller reference diameter, longer lesions, and experience a higher restenosis rate following angioplasty [35]. Also, long-term survival is better in multivessel patients treated with coronary artery bypass surgery than in those treated with coronary angioplasty [6]. However, the question remains whether the increased morbidity and mortality in diabetes is due to anatomical features or to other mechanisms."
http://www.medforum.nl/idm/coronary_atherosclerosis_and____.htm

Diabetics are prone to atherosclerosis and other complications:The internet Pathology Laboratory:"Persons with diabetes mellitus, either type I or type II, have early and accelerated atherosclerosis. The most serious complications of this are atherosclerotic heart disease, cerebrovascular disease, and renal disease. The most common cause of death with diabetes mellitus is myocardial infarction. Peripheral vascular disease is a particular problem with diabetes mellitus and is made worse through the development of diabetic neuropathy, leading to propensity for injury.The eyes can be affected in several ways by diabetes mellitus. Diabetic retinopathy is one of the leading causes for irreversible blindness in the United States. This retinopathy can occur with either type I or type II diabetes mellitus, usually a decade or so after the onset of diabetes. Most persons with type I diabetes and many of those with type II diabetes develop some background (non-proliferative ) retinopathy. Proliferative retinopathy is more ominous and is more likely to occur when diabetes mellitus is poorly controlled. In severe retinopathy, neovascularization may lead to adhesions (synechiae) between iris and cornea or iris and lens. Neovascularization of the iris leads to secondary glaucoma with blindness. Cataracts are more common in diabetics. This predilection for development of cataracts is felt to result from hyperglycemia leading to accumulation of sorbitol that results in osmotic damage to the crystalline lens."
http://www-medlib.med.utah.edu/WebPath/TUTORIAL/DIABETES/DIABETES.html

Vascular complications of diabetes:British Medical Journal:"A continuous relation exists between glycaemic control and the incidence and progression of microvascular complications. Hypertension and smoking also have an adverse effect on microvascular outcomes. In the diabetes control and complications trial--a landmark study in type 1 diabetes--the number of clinically important microvascular endpoints was reduced by 34-76% in patients allocated to intensive insulin (that is, a 10% mean reduction in glycated haemoglobin ([Hb.sub.A1c]) concentration from 8.0% to 7.2%). However, these patients also had more hypoglycaemic episodes. Similarly, in the UK prospective diabetes study of patients with type 2 diabetes, an intensive glucose control policy that lowered glycated haemoglobin concentrations by an average of 0.9% compared with conventional treatment (median [Hb.sub.A1c] 7.0% v 7.9%) resulted in a 25% reduction in the overall microvascular complication rate. It was estimated that for every 1% reduction in [Hb.sub.A1c] concentration there is a 35% reduction in microvascular disease."
http://www.findarticles.com/cf_dls/m0999/7241_320/61995034/p1/article.jhtml

How hyperglycemia promotes atherosclerosis:Biomed Central:"Both type I and type II diabetes are powerful and independent risk factors for coronary artery disease (CAD), stroke, and peripheral arterial disease. Atherosclerosis accounts for virtually 80% of all deaths among diabetic patients. Prolonged exposure to hyperglycemia is now recognized a major factor in the pathogenesis of atherosclerosis in diabetes. Hyperglycemia induces a large number of alterations at the cellular level of vascular tissue that potentially accelerate the atherosclerotic process. Animal and human studies have elucidated three major mechanisms that encompass most of the pathological alterations observed in the diabetic vasculature: 1) Nonenzymatic glycosylation of proteins and lipids which can interfere with their normal function by disrupting molecular conformation, alter enzymatic activity, reduce degradative capacity, and interfere with receptor recognition. In addition, glycosylated proteins interact with a specific receptor present on all cells relevant to the atherosclerotic process, including monocyte-derived macrophages, endothelial cells, and smooth muscle cells. The interaction of glycosylated proteins with their receptor results in the induction of oxidative stress and proinflammatory responses 2) oxidative stress 3) protein kinase C (PKC) activation with subsequent alteration in growth factor expression. Importantly, these mechanisms may be interrelated. For example, hyperglycemia-induced oxidative stress promotes both the formation of advanced glycosylation end products and PKC activation."
http://www.biomedcentral.com/1475-2840/1/1

Blocking "Rage" Prevents Diabetic Atherosclerosis:David Stern, Ann Marie Schmidt:"P&S researchers report that they have prevented the accelerated atherosclerosis associated with diabetes in mice by blocking activation of a cell-surface receptor called RAGE. Atherosclerosis is the major cause of death and disability for patients with diabetes, and people with diabetes account for more than half of all heart attacks in the United States. The research, reported in the September 1998 issue of Nature Medicine, suggests the discovery may provide the basis for new therapeutic strategies. Currently the only treatments for atherosclerosis associated with diabetes are control of blood sugar and conventional treatments for patients without diabetes. "Our research emphasizes a target that people didn't consider before. RAGE looks like it is a candidate for future therapy," says Dr. David Stern, professor of physiology and cellular biophysics and surgery. Dr. Stern and Dr. Ann Marie Schmidt, assistant professor of surgical science and of medicine, led the P&S research team."
http://cpmcnet.columbia.edu/news/journal/archives/jour_v19no1/rage.html

How Diabetes Causes Hypertension:Michael J. Quon, MD, PhD:"The hemodynamic response to insulin involves, in part, the concurrent release of endothelin and NO, and Dr. Quon believes that the imbalance between the release of these two substances may predispose to the development of hypertension and atherosclerosis. The endothelium produces NO in a regulated fashion; it has a vasodilatory effect stimulated by insulin, an effect opposed by the vasocontriction provided by endothelin. Vasodilation is impaired in insulin resistance."
apicenter@hotmail.com
http://stores.yahoo.com/apinet/emmecofdiabc.html

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Exercise may ease risk of diabetic heart disease:Kate N. Grossman:"Elevated levels of insulin appear to make people prone to blood clots, a finding that could explain why diabetics are so susceptible to heart attacks and strokes, researchers say. About 75 percent of people with the most common type of diabetes die of heart attacks or strokes. Previous studies have found that high blood pressure and low levels of "good" cholesterol account for about half of the higher-than-normal risk of cardiovascular disease in diabetics. This new study -- published in Wednesday's Journal of the American Medical Association -- tried to determine what role elevated insulin levels play. Based on their findings, the researchers suggest that exercise, which makes the body more receptive to the effects of insulin, might improve a person's ability to dissolve blood clots and possibly lower the risk of cardivascular disease. "Exercise ought to be really, really encouraged," said Dr. James B. Meigs, an internist at Massachusetts General Hospital in Boston."
http://www.southcoasttoday.com/daily/01-00/01-14-00/c02li076.htm

Diabetic Muscle Infarction triggered by an ischemic event:traders.co.uk:"The April issue of the Annals of the Rheumatic Diseases carries an article discussing and reporting on two cases of diabetic muscle infarction, a rare condition that "can be triggered by an ischemic event and cause extensive muscle necrosis through hypoxia-reperfusion injury and compartment syndrome." The authors report describe it as "a rare cause of acute severe muscle pain" and note that it must be distinguished from "focal or systemic myositis, localized abcess, hematoma, deep venous thrombosis, osteomyelitis, and muscle tumor (sarcoma or lymphoma)." Case 1. The authors describe the case of a 46 yr old Type 2 diabetic woman with nephropathy and proliferative retinopathy who presented to a hospital with a painful, swollen left leg after an insulin injection to her left leg. Doppler ultrasound excluded DVT and a CT scan showed swelling of the left vastus medialis muscle; muscle biopsy showed chronic inflammation. ESR was elevated, while ANCA, ANA and rheumatoid factor were negative. The woman was sent for further evaluation after lack of improvement with 6 wks treatment with steriods and antituberculosis drugs"
http://www.traders.co.uk/insulintrust/jan142002/id4.htm

Protein kinase C and the development of diabetic vascular complications:Pub Med National Libraray of Medicine:"Hyperglycemic control in diabetes is key to preventing the development and progression of vascular complications such as retinopathy, nephropathy and neuropathy. Increased activation of the diacylglycerol (DAG)-protein kinase C (PKC) signal transduction pathway has been identified in vascular tissues from diabetic animals, and in vascular cells exposed to elevated glucose. Vascular abnormalities associated with glucose-induced PKC activation leading to increased synthesis of DAG include altered vascular blood flow, extracellular matrix deposition, basement membrane thickening, increased permeability and neovascularization. Preferential activation of the PKCbeta isoform by elevated glucose is reported to occur in a variety of vascular tissues."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11903 393&dopt=Abstract


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Last updated by Andrew Lopez, RN on Wednesday, September 29, 2010


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