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Vascular Diseases: What Is Diabetic Angiopathy?

Vascular Diseases: What Is Diabetic Angiopathy? | UPMC Italy

Caring for vascular health is essential to ensure the proper functioning of the heart, brain, and other vital organs. If you have diabetes, keeping your blood vessels healthy becomes even more critical, as diabetes is closely linked to cardiovascular diseases.

People with diabetes are twice as likely to develop heart disease or suffer a stroke compared to those without diabetes. Additionally, the risk of heart problems increases at a younger age and grows as diabetes progresses.

According to a report published in the Journal of Diabetes Research, diabetic vascular complications are the leading cause of death among adults with diabetes. These complications can significantly impact vascular health in various ways. In this article, we’ll explore the link between diabetes and vascular diseases, with a particular focus on diabetic angiopathy.

If you have diabetes or are at risk of developing diabetic vascular disease, join the UPMC Salvator Mundi International’s Cardiology Open Day for a free consultation with one of our specialists.

The Vascular System

The vascular system, or circulatory system, consists of a network of blood vessels that transport blood throughout the body, ensuring the proper functioning of vital organs. This system is divided into two main circuits: the pulmonary vessels and the systemic vessels. Pulmonary vessels carry blood from the heart to the lungs for oxygenation and then back to the heart, while systemic vessels distribute oxygenated blood from the heart to tissues throughout the body and then return it to the heart.

The vascular system includes three main types of blood vessels:

  • Arteries: These vessels carry oxygen-rich blood from the heart to all parts of the body. Arteries are also used to measure blood pressure.
  • Veins: These carry deoxygenated blood from the tissues back to the heart, where it will be sent to the lungs for reoxygenation.
  • Capillaries: These are the smallest and most numerous blood vessels in the body, connecting arteries to veins. Capillaries play a crucial role in exchanging oxygen, nutrients, and waste products between the blood and tissue cells.

What Is Vascular Disease or Diabetic Angiopathy?

Diabetic angiopathy is a term that encompasses vascular diseases that develop as a consequence of diabetes. This condition occurs when diabetes causes the narrowing of arteries, which are responsible for transporting oxygen-rich and nutrient-rich blood to the body’s organs. The reduced blood flow impairs organ function and can lead to progressive damage.

Diabetes can cause both macrovascular and microvascular diseases:

  • Macrovascular Diseases: These involve large arteries and include conditions such as atherosclerosis, which can lead to heart attacks and strokes.
  • Microvascular Diseases: These affect small blood vessels and can cause damage to the retina (diabetic retinopathy), kidneys (diabetic nephropathy), and nerves (diabetic neuropathy).

Effective diabetes management is essential to prevent or slow the development of these vascular complications and maintain long-term health.

Macrovascular Diseases

Macrovascular diseases affect the large blood vessels, such as those supplying blood to the heart, brain, arms, and legs.

These conditions can have serious health consequences and include:

  • Cerebrovascular Disease: This disease damages the brain's blood vessels, which can rupture, bleed, or become blocked by fat deposits. Reduced or interrupted blood flow to the brain can cause a stroke, with potentially severe and lasting effects.
  • Cardiovascular Disease (CVD): This occurs when the blood vessels that supply the heart are damaged. Conditions like atherosclerosis, which involves plaque buildup in the arteries, increase the risk of a heart attack. CVD is one of the leading causes of death in patients with diabetes.
  • Peripheral Vascular Disease (PVD): This condition occurs when blood vessels in the legs and sometimes the arms are blocked, preventing adequate blood flow to the tissues.
  • Peripheral Arterial Disease (PAD): A form of PVD and diabetic arterial disease. PAD can cause wounds that don’t heal, gangrene, and, in severe cases, may require limb amputation.

Managing diabetes and regularly monitoring cardiovascular health are crucial to preventing or mitigating macrovascular complications.

Microvascular Diseases

Microvascular diseases affect the smaller blood vessels, such as those in the eyes, nerves, and kidneys.

When diabetes damages these vessels, various serious complications can arise, including:

  • Diabetic Retinopathy: Diabetes can damage the retina's blood vessels, the part of the eye responsible for vision. This damage can lead to vision problems that, if left untreated, can progress to blindness.
  • Diabetic Neuropathy: This occurs when the blood vessels that nourish the nerves are compromised. People with diabetic neuropathy may experience numbness, tingling, or pain in their hands and feet. In some cases, reduced sensitivity can lead to neglected wounds or infections in the feet, which may not heal properly and, in severe situations, require amputation.
  • Diabetic Nephropathy: This occurs when diabetes damages the blood vessels in the kidneys, impairing their ability to filter waste from the blood. This condition can progress to kidney failure, which may require dialysis in some cases.

How Diabetes Can Cause Vascular Diseases

Diabetes can cause significant damage to blood vessels and nerves, negatively affecting long-term vascular health.

High blood sugar levels, typical of diabetes, alter blood chemistry and composition, increasing the risk of cardiovascular diseases through various mechanisms:

  • Hypertension, or high blood pressure: This exerts excessive pressure on artery walls, causing damage and increasing the risk of hardening and blockage.
  • Excess LDL (“bad”) cholesterol: High levels of LDL cholesterol can lead to plaque formation on arterial walls. These plaques can block or harden the arteries, contributing to the development of atherosclerosis, a condition that increases the risk of heart attack and stroke.
  • High triglycerides: A high level of triglycerides, combined with excess LDL cholesterol and low levels of HDL (“good”) cholesterol, can accelerate the hardening and narrowing of arteries, further aggravating cardiovascular risk.

Preventing Diabetic Angiopathy

Preventing diabetic angiopathy is crucial, as damage to blood vessels can become apparent only when it is already advanced. It is essential to closely monitor diabetes and take preventive measures to avoid vascular damage.

Here are some key strategies for preventing vascular complications associated with diabetes:

  • Blood Sugar Control: Regularly visit your specialist and undergo periodic blood sugar and hemoglobin A1C tests to keep your blood sugar levels in check.
  • Cardiovascular Monitoring: It’s important to keep track of other heart health indicators, including:
    • Blood Pressure: Regularly monitor blood pressure to prevent hypertension.
    • Cholesterol Levels: Check and manage cholesterol levels to reduce the risk of atherosclerosis.
    • Body Mass Index (BMI): Monitor your weight and maintain a healthy BMI to reduce the risk of complications.

In addition to routine blood tests, your doctor may recommend further tests to assess vascular and heart health:

  • ECG (Electrocardiogram): Measures the heart's electrical activity and can detect abnormalities.
  • Echocardiogram: An ultrasound of the heart that helps evaluate heart function and identify structural problems.
  • Cardiac Catheterization: Examines the coronary vessels to check for plaque deposits and other abnormalities.
  • Angiogram: An X-ray that visualizes blood flow through veins and arteries to identify blockages or narrowings.

Taking these preventive measures can help maintain vascular health and reduce the risk of diabetic angiopathy, improving quality of life and preventing serious complications.

Treatment of Diabetic Vascular Disease

Treatment for diabetic angiopathy varies depending on the type of disease and its severity. Therapeutic approaches may include a combination of medication, surgical interventions, and lifestyle changes. Here’s an overview of the main treatments available:

  • Medications:
    • Blood Pressure Control: Antihypertensive medications may be prescribed to keep blood pressure under control and prevent further damage to blood vessels.
    • Cholesterol Reduction: Statins and other lipid-lowering drugs can help reduce LDL (“bad”) cholesterol levels and prevent atherosclerosis.
    • Anticoagulants: In some cases, they may be used to improve blood flow and prevent clot formation.
  • Surgical Interventions:
    • Artery Repair: If arteries are hardened, blocked, or narrowed, surgery may be necessary to restore blood flow. This may include procedures like angioplasty or stent placement.
    • Arterial Bypass: In more severe cases, bypass surgery may be needed to create a new pathway for blood flow.
  • Lifestyle Changes:
    • Balanced Diet: Following a healthy diet, low in saturated fats and rich in fruits, vegetables, and whole grains, is crucial for managing blood sugar and maintaining vascular health.
    • Regular Physical Activity: Consistent exercise can improve circulation, help maintain a healthy body weight, and reduce the risks associated with diabetes and vascular diseases.
    • Diabetes Management: Regularly monitor blood sugar levels and follow your doctor’s recommendations for diabetes treatment to prevent vascular conditions from worsening.

The possibility of reversing vascular damage depends on the severity of the disease and the timeliness of treatment. Detecting and treating diabetic vascular disease early greatly increases the chances of preventing further complications and improving quality of life.