Impact of the atherosclerotic process in patients with diabetes

Between 120 and 140 million people suffer from diabetes mellitus (type 1 and type 2) worldwide, and this number may well double by the year 2025. Patients with diabetes are at increased risk of atherosclerosis and its clinical sequelae: coronary, peripheral vascular, and cerebrovascular diseases. Concurrently, the most common cause of death in persons with diabetes is myocardial infarction. The pathogenesis, progression, and epidemiology of atherosclerotic disease are distinct in patients with diabetes. Atherosclerosis can develop much earlier in life, and at an accelerated rate, compared with non-diabetic individuals. One of the factors responsible for increased atherosclerosis is related to the atherogenic lipid profile in diabetes. The pathobiological processes that are responsible for transforming dormant atherosclerotic plaques into active rupture-prone plaques may be enhanced in diabetes as well. It follows that a major challenge in the treatment of patients with diabetes is to reduce the risk of atherosclerotic disease. The third National Cholesterol Education Program (NCEP) report recently recommended that the management of dyslipidaemia in patients with diabetes should be as aggressive as in those with established coronary heart disease (CHD). The NCEP Adult Treatment Panel III guidelines recommend statins for patients at elevated risk for CHD.