The role of hyperglycaemia and the hypercoagulable state in the pathogenesis of cardiovascular events in diabetes mellitus: implications for hypertension management.
Population studies have identified diabetes mellitus as a risk factor for cardiac and vascular events, with a common association with hypertension. Observational studies have consistently demonstrated blood glucose as a continuous cardiovascular risk factor. Experimental studies suggest that elevated blood glucose, through a range of biochemical pathways can promote atherogenesis and increase the tendency for thrombosis. The resultant state promotes occlusion of arterial flow and increase cardiovascular event rates. However, an unconvincing temporal relationship (raised blood glucose preceding cardiovascular events) and the limited impact of glucose reduction in patients with diabetes on cardiovascular events do not support blood glucose as a major cause of cardiovascular disease. In this review, we discuss the relationship between hyperglycaemia and a hypercoagulable state in diabetes and the implications of this relationship for the treatment of patients with diabetes, who also commonly have hypertension.
Lim
Hoong Sern
HS
Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham B18 7QH, England.
MacFadyen
Robert J
RJ
Bakris
George
G
Lip
Gregory Y H
GY
D001777:Blood Coagulation; D001786:Blood Glucose / Q000032:analysis; D002318:Cardiovascular Diseases / Q000209:etiology*; D048909:Diabetes Complications / Q000209:etiology*; D003920:Diabetes Mellitus / Q000097:blood* / Q000628:therapy; D003925:Diabetic Angiopathies / Q000209:etiology*; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D006973:Hypertension / Q000628:therapy*; D012307:Risk Factors; D033081:Shear Strength; D014841:von Willebrand Factor / Q000032:analysis
D001786:Blood Glucose; D014841:von Willebrand Factor