[Control of atherosclerosis in diabetes mellitus]

Diabetic patients develop atherosclerosis in an accelerated way as compared to non-diabetic patients. This is due to a generalized metabolic disorder that includes hyperglycemia, insulin resistance, dyslipidosis, loss of the endothelial regulatory function, a tendency for vasoconstriction, and a prothrombotic state. The main complications are coronary artery disease, peripheral vascular disease, and cerebrovascular disease. In all these manifestations and at all severity levels, diabetic patients, in particular post-menopausal women, have the worst prognosis with any type of treatment as compared to non-diabetic patients. These findings lead to consider the sole presentation of diabetes mellitus to be equivalent to cardiovascular risk. The largest reduction in risk is achieved by controlling hypertension, followed by a control of glycemia, reduction of glycosylated hemoglobulin and control of dyslipidosis. Benefits in the cardiovascular realm have not extended to other vascular territories, such as the lower extremities or the brain.