Macrovascular Risk Reduction in Diabetes

Macrovascular disease affects the large arteries supplying the heart, brain, and limbs. In diabetes, the major consequences are coronary artery disease, ischemic stroke, transient ischemic attack, and peripheral arterial disease. Persistently elevated glucose injures vascular endothelium through glycation, oxidative stress, and inflammation. The endothelium becomes less able to regulate vascular tone and resist plaque formation. Dyslipidaemia, hypertension, smoking, chronic kidney disease, and central adiposity amplify that injury. Atherosclerotic plaque then develops more quickly and becomes more likely to rupture. The clinical implication is larger than glucose control alone. A person may have an acceptable A1C and still face substantial cardiovascular risk because blood pressure, LDL-C, kidney disease, or tobacco exposure continue to damage arteries. Macrovascular prevention therefore treats the entire risk pattern rather than pursuing a glucose number in isolation.