Hippokratia 2005, 9(2):73-79
2nd Dpt Internal Medicine, Hippokratio General Hospital, Thessaloiki, Greece
It is well known that type 2 diabetes is a major risk factor for atherosclerosis and coronary artery disease. Recently, a large amount of evidence, suggests that this relation possibly is deeper and the metabolic disorders initiating both diseases may be common. This article is a review of the pathogenetic mechanisms by which the metabolic disorders leading to or caused by type 2 diabetes are leading to atherogenesis and coronary artery disease. The pathogenesis of type 2 diabetes and the epidemiological evidence confirming the correlation between diabetes and atherogenesis are also briefly discussed. Particularly, the relationship between insulin resistance with the concomitant hyperinsulinaemia and the atherogenesis is reviewed; the effect of fasting plasma glucose, postprandial hyperglycaemia, good glycaemic control (measured by means of HbA1c) as well as the oxidation and glycosylation of plasma and cell membrane proteins on the mechanisms of atherogenesis is discussed. Finally, the possible relation between gene polymorphisms and pathogenesis of atherosclerosis in type 2 diabetic patients is reviewed. It seems that insulin resistance, the initial perturbation of type 2 diabetes mellitus and metabolic syndrome, and the impaired endothelial function, central component of atherogenesis, are often silent partners that present many years before the onset of type 2 diabetes mellitus. Therefore, strategies of early diagnosis and management of both diseases is of increased importance.