[Mechanism of diabetic macroangiopathy]

Diabetes is a strong risk factor for cardiovascular diseases. Hyperglycemia at post-prandial as well as fasting state explains a part of the risk. Several disorders induced by hyperglycemia such as activation of PKC, increased glycosylation and oxidative stress have been proposed as the underlying mechanisms. In addition to the hyperglycemia, several epidemiological studies have suggested that hyperinsulinemia or insulin-resistance is also associated with the cardiovascular diseases. Endothelial dysfunction and/or inflammation are postulated as key players in the hyperinsulinemic or insulin-resistant state. Recently, we found that insulin stimulates the proinflammatory gene expression in cultured vascular cells. In this article, I reviewed these hypothesis explaining how hyperglycemia or insulin-resistance caused macroangiopathy in diabetics.