John Libbey Eurotext




Arterial remodeling in diabetes
Sang Thrombose Vaisseaux. Volume 17, Number 1, 14-22, Janvier 2005, Mini-revue
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Author(s) : Pierre Boutouyrie, Anne-Isabelle Tropeano, Stéphane Laurent
Summary : The rising frequency of type 2 diabetes is a major health problem. The clinical complications of diabetes are strongly linked to micro and macrovascular lesions. The earliest stage of vascular disease is endothelial dysfunction, consequence of increased oxidative stress, secretion of growth factors, activation of transduction pathways, inflammation and accumulation of end-glycation products. It leads to decreased vasodilatory properties, proliferation of vascular smooth muscle cells, increased extracellular matrix production and finally increased stiffness/thickness of vessels. In the long term, these abnormalities are aggravated by the coexistence of other cardiovascular risk factors such as hypertension, dyslipidemia and obesity. The association of risk factors may be observed in the metabolic syndrome, leading to early and severe atherosclerosis. The long term prognosis is bad, comparable with most severe diseases. Therapeutic management is based on a multidisciplinary approach – dietetic, lipid and blood pressure lowering – leading to a marked improvement in prognosis. Screening for early stages of vascular disease in diabetic patients, for increased arterial stiffness and thickness, and altered endothelial function may lead to early treatment and the prevention of major cardiovascular events. Specific treatments for early arterial lesions are still under validation. Advanced glycation end-products breakers have shown a pressure-independent effect on large artery disease and may represent the first of a new family of medications.
Keywords : diabetes, arterial hypertension, remodelling, atherosclerosis, arterial rigidity, intima-media thickness

Arterial remodeling in diabetes