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Contents

Introduction Endothelial Dysfunction

Quantitative/Qualitative Abnormalities of Lipoproteins Abnormalities in Platelet Function Abnormalities in Coagulation Abnormalities in the Fibrinolytic System References introduction

Macrovascular disease is the leading cause of mortality and morbidity in diabetes. The study of factors that may uniquely contribute to the accelerated development of atherosclerosis in diabetes has been an ongoing process for several years. However, the concepts behind both the pathogenic mechanisms of atherosclerosis and the trigger mechanisms that lead to acute clinical events have drastically changed in the last two decades. It is now fully accepted that arteriosclerosis is a chronic inflammatory process and not a degenerative process that inevitably progresses with age. Also accepted is the fact that plaque rupture or erosion not the degree of vessel obstruction is responsible for the majority of acute cardiovascular events. Diabetes most likely contributes to and enhances the chronic inflammatory process characteristic of arteriosclerosis and supporting this concept are the studies showing that atherectomy specimens from diabetic patients undergoing coronary atherectomy for symptomatic coronary artery disease (CAD) have a larger content of macrophages than specimens from patients without diabetes (1). In recent years, mechanisms that lead to plaque formation and to plaque erosion or rupture and the key event that precedes both, endothelial dysfunction, are being actively studied (Fig. 1).

The earliest atherosclerotic lesion is the fatty streak that, although not clinically significant on its own, plays a significant role in the events that lead to plaque progression and rupture. Formation of fatty streaks is induced by the transport of lipoproteins across the endothelium and their retention in the vessel wall. Schwenke and associates (2) have

From: Contemporary Cardiology: Diabetes and Cardiovascular Disease, Second Edition Edited by: M. T. Johnstone and A. Veves © Humana Press Inc., Totowa, NJ

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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