IngentaConnect Evolution and Progression of Arterial Occlusive Disease in Patien...

Abstract:

Atherosclerotic disease, which is the obstruction of blood flow into an arterial tree, is a worldwide leading cause of death and loss of disability-adjusted life-years. Although as many as 300 risk factors are associated with atherosclerosis, about 70-90% of these are secondary to various associations between conventional risk factors, such as diabetes, increased age, obesity, gender, family history, systolic blood pressure, total serum cholesterol, and tobacco use.

The prevalence of atherosclerotic disease in persons with diabetes has been reported as high as 30%, two to three times that of nondiabetic patients, and is the major cause of morbidity and mortality in this patient population. The severity, progression, and associated total mortality for atherosclerotic disease are also greater in persons with diabetes than in those without. Unfortunately, the recent encouraging data that demonstrates a decrease in atherosclerotic cardiovascular disease mortality in the general U.S. population was not reflected in the diabetic population.

People with diabetes, in contrast to those without, generally have more severe and more diffuse atherosclerotic disease, which can lead to accelerated cerebral, coronary, and peripheral artery disease. Characteristic features of lower limb atherosclerotic lesions in patients with diabetes include more prominent calcification of the intima media, frequent involvement of distal vascular segments, and asymmetry of lesions. This accelerated atherosclerotic process and the increased risk of thrombotic vascular events in people with diabetes may result from dyslipidemia, endothelial dysfunction, platelet hyperreactivity, impaired fibrinolytic balance, or abnormal blood flow.

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Evolution and Progression of Arterial Occlusive Disease in Patients With Diabetes