Macrovascular disease in diabetes: current status

Clearly, macrovascular complications are the prognosis limiting problem of diabetes patients which consecutively account for the majority of socio-eco nomic burden of the disease. The overall morbidity and mortality developmen t does not indicate improvement hallmarking better or at least adequate car e for these patients. Possible explanations address the late detection prob lem of a clinically silent disease onset as well as unrecognised multiple c omorbid conditions all of which end-up with en dothelial dysfunction as rep resentation of the so called "functional atherosclerosis" and blood hyper r esponsiveness. Here, we describe new experimental aspects of the early athe rosclerosis development focussing inflammation as one driving pathogenetic force for the evolution of the complicated lesion type in diabetes. However , emphasis is put on the view that inflammation, atherogenesis and thrombog enesis are severely crosslinked by soluble and cellular adhesion molecules. From a diagnostic point of view genomic detection of risk associated genes opens both the vision of early identification of high risk individuals and the targetting of drug intervention based on conditioned responsiveness. B y using available drugs and evidence based risk factor intervention strateg ies a plea is made for a multimodal therapeutic approach fitted to the indi vidual patient's needs aiming at endpoint reduction. This corresponds to th e recent releases of guidelines from nearly all vascular medicine related s cientific societies. Diabetes is a vascular disease!