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Interactions between microvascular and macrovascular disease in diabetes: pathophysiology and therapeutic implications
Author(s) -
Krentz Andrew J.,
Clough Geraldine,
Byrne Christopher D.
Publication year - 2007
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/j.1463-1326.2007.00670.x
Subject(s) - medicine , macrovascular disease , diabetes mellitus , nephropathy , disease , retinopathy , vascular disease , polypharmacy , intensive care medicine , pathophysiology , diabetic retinopathy , diabetic nephropathy , bioinformatics , cardiology , type 2 diabetes , endocrinology , biology
Convention partitions the complications of diabetes into two main subtypes. First are the diabetes‐specific microvascular complications of retinopathy, nephropathy and neuropathy; second are the atherothrombotic macrovascular complications that account for the majority of premature deaths. Pathological interactions between microvascular and macrovascular complications, for example, nephropathy and macrovascular disease, are common. Similar mechanisms and shared risk factors drive the development and progression of both small and large vessel disease. This concept has therapeutic implications. Mounting evidence points to the need for multifactorial strategies to prevent vascular complications in subjects with diabetes and/or the metabolic syndrome. We advocate a combined therapeutic approach that addresses small and large vessel disease. Preferential use should be made of drug regimens that (i) maximize vascular protection, (ii) reduce the risk of iatrogenic vascular damage and (iii) minimize the increasing problem of polypharmacy.