Macrovascular Risk Reduction in Diabetes

Diabetes increases the risk of coronary artery disease, ischemic stroke, and peripheral arterial disease because chronic hyperglycemia injures vascular endothelium and promotes inflammation. Insulin resistance, hypertension, dyslipidemia, and central adiposity often travel with diabetes, creating several simultaneous pathways to plaque formation. Atherosclerotic plaque is not simply a cholesterol deposit. It is an inflamed, unstable area within an artery. When plaque narrows a coronary artery, the patient may develop exertional angina or an acute coronary syndrome. In cerebral arteries, plaque or thrombus can cause a transient ischemic attack or ischemic stroke. In leg arteries, reduced flow causes claudication, impaired wound healing, and potentially limb-threatening ischemia. Glucose control matters, but an acceptable A1C does not mean cardiovascular risk is controlled. A patient with an A1C near goal can still have an LDL-C of 130 mg/dL, persistent hypertension, tobacco exposure, and silent peripheral arterial disease. Macrovascular prevention therefore targets the whole risk pattern rather than glucose alone.