There is an evident relationship between diabetes and risk of vascular disease. Diabetes promotes vascular disease through various mechanisms. The consequence of this is the appearance of atheromatosis in different arteries, which can affect any vascular area of the body. The arteries that most frequently suffer from atherosclerosis in diabetes are the coronary arteries, the cerebral arteries and the arteries of the lower extremities.
Diabetes and risk of vascular disease
Diabetes is associated with a generalized inflammatory state, as inflammatory mediators increase in the blood. These include tumor necrosis factor alpha and proinflammatory cytokines. These substances can damage the walls of the arteries and lead to atherosclerosis.
On the other hand, increased glucose also contributes to arterial damage, as well as increased cholesterol in the blood, which is common in diabetes. Coronary artery damage caused by atherosclerosis eventually causes angina and myocardial infarction. Damage to the cerebral arteries leads to stroke. And blockage of the arteries in the lower limbs can lead to gangrene in the legs.
Diabetes and coronary heart disease
Diabetics have a 2- to 4-fold increased risk of coronary heart disease than non-diabetics. Diabetic men have a significantly higher risk of heart attack than non-diabetics. In the general population, women have a lower risk of heart attack than men. This is probably due to the relative protection provided by female hormones. Women usually develop coronary heart disease about 10 years later than men. However, diabetes counteracts this benefit and diabetic women have a higher risk of heart attack than non-diabetic men and women.
In some studies, a higher risk of myocardial infarction has even been observed in diabetic women than in diabetic men. The probability of a previously healthy diabetic suffering a heart attack is the same as that of a non-diabetic patient who has already had a myocardial infarction. On the other hand, it has been observed that younger diabetics have a higher mortality rate due to heart attack than older diabetics. Finally, diabetics who have had a myocardial infarction also have a higher risk of stroke, heart failure and cardiovascular death.
Diabetes and cerebrovascular disease
The prevalence of stroke in diabetics is three times that of non-diabetics, and the incidence is up to four times higher. Diabetics who are at higher risk of stroke are those with more severe diabetes and those with insulin resistance. Diabetes reduces the age of onset of stroke, such that diabetics under 55 years of age have a risk of stroke 10 times higher than non-diabetics of the same age.
Many studies have shown that diabetes increases the risk of stroke more in women than in men. In addition, diabetic women have a higher risk of death from stroke than diabetic men. Among individuals who have already suffered a stroke, diabetics also have a higher risk of repeat stroke than non-diabetics. Furthermore, it is known that cerebral artery disease can lead to dementia, and this risk is higher in diabetics.
Diabetes and lower extremity arterial disease
Diabetes also increases the incidence of arterial disease in the lower extremities and other arteries of the body by 2–4 times. The prevalence of peripheral arterial disease in diabetics is greater than 12%, varying according to region, reaching up to 30% in some geographic areas. The prevalence and severity of peripheral arterial disease is directly proportional to the degree of hyperglycemia and the duration of diabetes. The involvement of the arteries of the lower extremities is more diffuse and with more vascular calcification in diabetics than in non-diabetics.
Among people with lower-extremity arterial disease, diabetics experience intermittent claudication more frequently and more severely than non diabetics. Severe limb ischemia and amputation risk are also more common in diabetics, particularly in men. Diabetics have a 12-fold higher risk of limb amputation than non diabetics, and this risk is up to 23-fold higher in diabetics aged 65 years or older. Lower-extremity ischemia due to diabetes is the most common cause of amputation in some countries.
Conclusion
From all of the above, it can be deduced that preventive measures must be strictly applied to diabetics. In some places, the lack of awareness among diabetics regarding their care is striking, so that they do not follow their diet properly, do not do physical exercise and, what is worse, many are smokers. This highlights the need for real health education programs aimed at the diabetic population. Diabetics must be made aware that it is vital for them to strictly apply cardiovascular prevention measures. They should follow a diet low in saturated fats and refined sugars, and rich in vegetables and fish, as well as doing physical exercise regularly and, of course, never smoking.