Diabetes mellitus and vascular lesions

Cardiovascular complications represent by far the most severe manifestation s of diabetes mellitus. Treatment aimed at stopping progression of vascular lesions may fall short if initiated when the disease becomes clinically ev ident. Therefore, identification of the earliest vascular disfunctions may offer the best opportunity to interfere with pathogenic mechanisms and avoi d progression of diabetic vasculopathy. In this report, we present a few me chanisms that alter hemodynamic and metabolic homeostasis in the course of diabetes mellitus. Endothelial function with special emphasis on nitric oxi de and oxidative stress, advanced glycation end products, and the renin ang iotensin system are briefly discussed. New pharmacological agents that may favorably influence these parameters are presently undergoing clinical tria ls. However, tight control of plasma glucose and cardiovascular risk factor s represent the cornerstone of the treatment in diabetes to slow progressio n of vascular disease. Copyright (C) 1998 by W.B. Saunders Company.