Atherosclerosis (hardening of the arteries)

ATHEROSCLEROSIS IS A disease of the arteries whereby plaques of fatty material are
deposited within the inner walls of the blood vessel, causing narrowing and hardening. This
condition causes heart attacks, strokes, and peripheral vascular disease, which are collectively known as cardiovascular diseases. Diabetes greatly increases the risk of developing atherosclerosis.

Atherosclerosis is popularly but incorrectly imagined as cholesterol slowly clogging the arteries, much as sludge might build up in a pipe. In actuality, it results from injury to the artery, although the exact cause of the injury is unknown. There are many contributing factors, including but not limited to age, genetics, smoking, diabetes, stress, high blood pressure, and lack of physical activity. Any breach of the artery’s walls can initiate an inflammatory cascade. Cholesterol (a waxy, fat-like substance found in all cells of the body) infiltrates the damaged area and narrows the blood vessel. The smooth muscle that supports the tissue of the blood vessel proliferates, and collagen, a structural protein found abundantly in the body, also accumulates in response to this injury. Again, the result is a further narrowing of the blood vessel. Rather than a single episode that can be simply repaired, this response occurs in reaction to chronic injuries to the vessel wall.

The end result is the development of plaque, known as the atheroma, which is a pocket of cholesterol, smooth muscle cells, and inflammatory cells inside the blood vessel wall.
This progressively limits the flow of blood to affected organs. If this atheroma ruptures, a blood clot forms. The sudden blockage of the artery by the clot prevents normal blood circulation and starves the downstream cells of oxygen, causing cell death and cardiovascular disease.
Heart disease

HEART ATTACKS, KNOWN medically as myocardial infarctions, are the most well recognized and feared complication of diabetes. They are caused by atherosclerosis of the blood vessels supplying the heart. 

The sudden blockage of these arteries starves the heart of oxygen, resulting in the death of part of the heart muscle.

The Framingham studies of the 1970s established a strong association between heart disease and diabetes.
Diabetes increases the risk of cardiovascular disease two- to fourfold, and these complications develop at a younger age compared to nondiabetics.

Sixty-eight percent of diabetics aged sixty-five or older will die of heart disease, and a further 16 percent will die of stroke.

 Reducing the risk of macrovascular disease is therefore of primary importance. The extent of death and disability resulting from cardiovascular diseases is many times greater than that resulting from microvascular diseases.

Over the past three decades, there have been significant improvements in the treatment of heart disease, but gains for diabetic patients have lagged far behind. While the overall death rate for nondiabetic men has decreased by 36.4 percent, it has only decreased 13.1 percent for diabeticmen.

ASTROKE IS caused by atherosclerosis of the large blood vessels supplying the brain. A
sudden disruption of the normal blood flow starves the brain of oxygen and a portion of the
brain may die. Symptoms vary depending upon which part of the brain is affected, but the
devastating impact of stroke cannot be underestimated. In the United States, it is the third
leading cause of death and the biggest contributor to disability.
Diabetes is a strong independent risk factor in stroke, meaning that, on its own,
diabetes increases a person’s risk of having a stroke by as much as 150–400 percent.

Approximately a quarter of all new strokes occur in diabetic patients.
15 Every year of
diabetes increases the risk of stroke by 3 percent,
 and the prognosis is also far worse.
Peripheral vascular disease
PERIPHERAL VASCULAR DISEASE (PVD) is caused by atherosclerosis of the large blood vessels
supplying the legs. The disruption of normal blood flow starves the legs of oxygen-carrying hemoglobin. The most common symptom of PVD is pain or cramping that appears with walking and is relieved by rest. As the blood vessels narrow and circulation worsens, pain
may also appear at rest and especially at night. PVD significantly reduces mobility, which can
lead to long-term disability.

Skin with a poor blood supply is more likely to be damaged and takes longer to heal. In
diabetics, minor cuts or injuries to the feet may become non-healing foot ulcers. In severe
cases, these areas where the skin has broken down, revealing underlying tissue, can
progress to gangrene. At this point, blood supply has been greatly reduced or completely
lost, the tissue dies, and amputation of the affected limb—a treatment of last resort—often
becomes necessary to treat chronic infections and relieve pain.

Diabetes, along with smoking, is the strongest risk factor for PVD. Approximately 27
percent of diabetic patients with PVD will progressively worsen over a five-year period, and
4 percent of them will need an amputation.

 Patients with gangrene and those requiring
amputation may never walk again, which can result in a cycle of disability. A loss of function of the limbs leads to less physical activity, which in turn leads to progressive deconditioning of the muscles. Weaker muscles lead to less physical activity, and the cycle repeats.

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