There are several possible mechanisms that make this group particularly vulnerable to atherosclerosis. An example of mechanism is non-enzymatic glycation of lipoproteins, which promotes uptake of cholesterol by scavenger macrophages. Furthermore, pro-thrombotic and anti-fibrinolytic properties of diabetes can also contribute to this vulnerability. The high prevalence of endothelial dysfunction among diabetes group leads to reduced bioavailability of NO and enhanced leukocyte adhesion. The most effective prevention of atherosclerosis among diabetes group is tight regulation of serum glucose levels. This intervention significantly reduces the risk of microvascular complications such as retinopathy and nephropathy. Furthermore, intense anti-diabetic regime also reduced macrovascular outcomes such as MI and stroke among a group of diabetes type 1. Additionally managing hypertension and dyslipidemia among diabetic groups also significantly reduces the risk of cardiovascular diseases. References 1. Estruch R, Ros E, and Mart nez-Gonz lez MA. Mediterranean diet for primary prevention of cardiovascular disease. N Engl J Med. 2013 Aug 15;369(7):676-7. DOI:10.1056/NEJMc1306659 | 2. Anderson J.L., Carlquist J.F., Muhlestein J.B., et al. Evaluation of C-reactive protein, an inflammatory marker, and infectious serology as risk factors for coronary artery disease and myocardial infarction. J Am Coll Cardiol 1998; 32:35. 3. Barua R.S., Ambrose J.A., Eales-Reynolds L.J., et al. Dysfunctional endothelial nitric oxide biosynthesis in healthy smokers with impaired endothelium-dependent vasodilatation. Circulation 2001; 104:1905. 4. Barter P.J., Caulfield M., Eriksson M., et al. Effects of torcetrapib in patients at high risk for coronary events. N Engl J Med 2007; 357:2109. 5. Bazzano L.A., He J., Muntner P., et al. Relationship between cigarette smoking and novel risk factors for cardiovascular disease in the United States. Ann Intern Med 2003; 138:891. https://www.textbookofcardiology.org/wiki/Atherosclerosis 21/26 7/4/23, 12:20 AM Atherosclerosis - Textbook of Cardiology 6. Bennet A., Di Angelantonio E., Erqou S., et al. Lipoprotein(a) levels and risk of future coronary heart disease: large-scale prospective data. Arch Intern Med 2008; 168:598. 7. Blood Pressure Lowering Treatment Trialists' Collaboration, Turnbull F., Neal B., et al. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. BMJ 2008; 336:1121. 8. Burke A.P., Farb A., Malcom G.T., Liang Y., Smialek J.E., Virmani R. "Plaque rupture and sudden death related to exertion in men with coronary artery disease." JAMA. 1999;281(10):921. 9. Camm A.J., F scher T.F., Serruys P.W., eds. (2010). The ESC Textbook of Cardiovascular Medicine Online Second Edition. Oxford: Oxford University Press. 10. Celermajer D.S., Sorensen K.E., Georgakopoulos D., et al. Cigarette smoking is associated with dose-related and potentially reversible impairment of endothelium-dependent dilation in healthy young adults. Circulation 1993; 88:2149. 11. Dauchet L., Amouyel P., Dallongeville J. Fruit and vegetable consumption and risk of stroke: a meta- analysis of cohort studies. Neurology 2005; 65:1193. 12. De Backer G., Ambrosioni E., Borch-Johnsen K., et al. European guidelines on cardiovascular disease prevention in clinical practice: third joint task force of European and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of eight societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2003; 10:S1. 13. Downs J.R., Clearfield M., Weis S., Whitney E., Shapiro D.R., Beere P.A., Langendorfer A., Stein EA, Kruyer W, Gotto AM Jr. "Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study." JAMA. 1998;279(20):1615. 14. Eckel R.H., York D.A., R ssner S., et al. Prevention Conference VII: Obesity, a worldwide epidemic related to heart disease and stroke: executive summary. Circulation 2004; 110:2968. 15. Emerging Risk Factors Collaboration, Erqou S., Kaptoge S., et al. Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality. JAMA 2009; 302:412. 16. Fuchs C.S., Stampfer M.J., Colditz G.A., et al. Alcohol consumption and mortality among women. N Engl J Med 1995; 332:1245. https://www.textbookofcardiology.org/wiki/Atherosclerosis 22/26 7/4/23, 12:20 AM Atherosclerosis - Textbook of Cardiology 17. Grady D., Herrington D., Bittner V., et al. Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA 2002; 288:49. 18. Harker L.A., Ross R., Slichter S.J., Scott C.R. Homocystine-induced arteriosclerosis. The role of endothelial cell injury and platelet response in its genesis. J Clin Invest 1976; 58:731. 19. Haffner S.M., Lehto S., R nnemaa T., et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339:229. 20. Howard G., Wagenknecht L.E., Burke G.L., Diez-Roux A., Evans G.W., McGovern P., Nieto F.J., Tell in G.S. "Cigarette smoking and progression of atherosclerosis: The Atherosclerosis Risk Communities (ARIC) Study." JAMA. 1998;279(2):119. 21. Jackson R., Scragg R., Beaglehole R. Alcohol consumption and risk of coronary heart disease. BMJ 1991; 303:211. 22. Jee S.H., Suh I., Kim I.S., Appel L.J. "Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol: the Korea Medical Insurance Corporation Study." JAMA. 1999;282(22):2149. 23. Kannel W.B., D'Agostino R.B., Belanger A.J. Fibrinogen, cigarette smoking, and risk of cardiovascular disease: insights from the Framingham Study. Am Heart J 1987; 113:1006. 24. Klein S., Burke L.E., Bray G.A., et al. Clinical implications of obesity with specific focus on cardiovascular disease: a statement for professionals from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 2004; 110:2952. 25. Knoops K.T., de Groot L.C., Kromhout D., et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 2004; 292:1433. 26. Kwaliteitsinstituut voor de gezondheidszorg CBO and Nederlandse Huisartsen Genootschap. (2006). Multidisciplinaire richtlijn cardiovasculair risicomanagement 2006. Alphen aan den Rijn: Van Zuiden Communications. 27. Lilly L.S. (ed.). (2007). Pathophysiology of Heart Disease. Baltimore: Lippincott Williams & Wilkins, p. 118 140. https://www.textbookofcardiology.org/wiki/Atherosclerosis 23/26 7/4/23, 12:20 AM Atherosclerosis - Textbook of Cardiology 28. Lilly L.S. (ed.). (2007). Pathophysiology of Heart Disease. Baltimore: Lippincott Williams & Wilkins, p. 118 140. 29. Nordmann A.J., Suter-Zimmermann K., Bucher H.C., et al. Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors. Am J Med 2011; 124:841. 30. Mancia G., Messerli F., Bakris G., et al. Blood pressure control and improved cardiovascular outcomes in the International Verapamil SR-Trandolapril Study. Hypertension 2007; 50:299. 31. McCully K.S. Vascular pathology of homocysteinemia: implications for the pathogenesis of arteriosclerosis. Am J Pathol 1969; 56:111. 32. Mendis S., Puska P., Norrving B. (eds.). (2011). Global Atlas on Cardiovascular Disease Prevention and Control. Geneva: World Health Organization. 33. Mukamal K.J., Chung H., Jenny N.S., et al. Alcohol consumption and risk of coronary heart disease in older adults: the Cardiovascular Health Study. J Am Geriatr Soc 2006; 54:30. 34. Newby D.E., Wright R.A., Labinjoh C., et al. Endothelial dysfunction, impaired endogenous fibrinolysis, and cigarette smoking: a mechanism for arterial thrombosis and myocardial infarction. Circulation 1999; 99:1411. 35. 'Keefe O'Keefe J.H., Bybee K.A., Lavie C.J. Alcohol and cardiovascular health: the razor-sharp double-edged sword. J Am Coll Cardiol 2007; 50:1009. 36. Paffenbarger R.S. Jr, Hyde R.T., Wing A.L., et al. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med 1993; 328:538. 37. Pasceri V., Cheng J.S., Willerson J.T., et al. Modulation of C-reactive protein-mediated monocyte chemoattractant protein-1 induction in human endothelial cells by anti-atherosclerosis drugs. Circulation 2001; 103:2531. 38. Pasceri V., Willerson J.T., Yeh E.T. Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation 2000; 102:2165. 39. Pearson T.A., Mensah G.A., Alexander R.W., et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003; 107:499. https://www.textbookofcardiology.org/wiki/Atherosclerosis 24/26 7/4/23, 12:20 AM Atherosclerosis - Textbook of Cardiology 40. Poirier P., Giles T.D., Bray G.A., et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 2006; 113:898. 41. Powell K.E., Thompson P.D., Caspersen C.J., Kendrick J.S. Physical activity and the incidence of coronary heart disease. Annu Rev Public Health 1987; 8:253. 42. Reaven G., Tsao P.S. Insulin resistance and compensatory hyperinsulinemia: the key player between cigarette smoking and cardiovascular disease? J Am Coll Cardiol 2003; 41:1044. 43. Ridker P.M., Cushman M., Stampfer M.J., et al. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 1997; 336:973. 44. Ridker P.M., Glynn R.J., Hennekens C.H. C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first myocardial infarction. Circulation 1998; 97:2007. 45. Rimm E.B., Ascherio A., Giovannucci E., et al. Vegetable, fruit, and cereal fiber intake and risk of coronary heart disease among men. JAMA 1996; 275:447. 46. Rolland P.H., Friggi A., Barlatier A., et al. Hyperhomocysteinemia-induced vascular damage in the minipig. Captopril-hydrochlorothiazide combination prevents elastic alterations. Circulation 1995; 91:1161. 47. Ronksley P.E., Brien S.E., Turner B.J., et al. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ 2011; 342:d671. 48. Rose G., Hamilton P.J., Colwell L., Shipley M.J. A randomised controlled trial of anti-smoking advice: 10-year results. J Epidemiol Community Health 1982; 36:102. 49. Rossouw J.E., Anderson G.L., Prentice R.L., et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA 2002; 288:321. 50. Rozanski A., Blumenthal J.A., Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999; 99:2192. 51. Rubin R., Strayer D.S., Rubin E. (ed.). (2008). Rubin's Pathology: Clinicopathologic Foundations of Medicine Fifth Edition. Baltimore: Lippincott Williams & Wilkins, p387-408 https://www.textbookofcardiology.org/wiki/Atherosclerosis 25/26 7/4/23, 12:20 AM Atherosclerosis - Textbook of Cardiology 52. Sacks F.M., Pfeffer M.A., Moye L.A., Rouleau J.L., Rutherford J.D., Cole T.G., Brown L., Warnica J.W., Arnold J.M., Wun C.C., Davis B.R., Braunwald E. "The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators." N Engl J Med. 1996;335(14):1001. 53. Shepherd J., Cobbe S.M., Ford I., Isles C.G., Lorimer A.R., MacFarlane P.W., McKillop J.H., Packard C.J. "Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group." N Engl J Med. 1995;333(20):1301. 54. Stefanadis C., Tsiamis E., Vlachopoulos C., et al. Unfavorable effect of smoking on the elastic properties of the human aorta. Circulation 1997; 95:31. 55. Tall, A. R. "CETP inhibitors to increase HDL cholesterol levels." N.Engl.J.Med. 356.13 (2007): 1364- 66. 56. The health benefits of smoking cessation. A report of the Surgeon General. DHHS Publication (CDC) 90-8416; U.S. Department of Health and Human Services, Washington, DC, 1990. 57. Theorell, T., Lind, E., Floderus, B. The relationship of disturbing life-changes and emotions to the development of myocardial infarction and other serious diseases. Int J Epidemiol 1975; 4:281. 58. Vita J.A., Keaney J.F. Jr. Endothelial function: a barometer for cardiovascular risk? Circulation 2002; 106:640. Retrieved from "http://www.textbookofcardiology.org/index.php?title=Atherosclerosis&oldid=2501" This page was last edited on 8 December 2013, at 20:56. Content is available under Attribution-NonCommercial-ShareAlike 3.0 Unported unless otherwise noted. https://www.textbookofcardiology.org/wiki/Atherosclerosis 26/26