Vascular complications

Diabetes continues to be a major cause of excessive morbidity, severe disability and premature death in Western populations. In developed countries, the cost of diabetes to society may be estimated to be as high as 5% of the total health costs, much of which relates to the chronic vascular complications of this disorder (Williams, 1991). The vascular lesion in diabetes consists of (1) microangiopathy, distinguished by thickening of capillary basement membranes resulting in increased vascular permeability, which is clinically manifested as diabetic retinopathy (Fig. 12.1a) and/or nephropathy (Fig. 12.1b), and (2) macroangiopathy (Fig. 12.2),... 

Sinclair A.J. (1993). Free radical mechanisms and vascular complications of diabetes mellitus. Diabet. Rev. 2, 7-10. 

Pivotal pre-approval safety and efficacy was assessed in a randomized, open label, multicentre study of infertile females undergoing in vitro fertilization and embryo transfer. The primary efficacy parameter was the mean number of oocytes retrieved, which (at 13.6) was similar to the number retrieved when urinary-derived hCG was used. Serious potential side effects can include ovarian over/hyper-stimulation, sometimes with pulmonary or vascular complications. The product is marketed by Serono Inc. 

CHCs should be avoided in women with SLE and antiphospholipid antibodies or vascular complications. Progestin-only contraceptives can be... 

Since it has been reported that hypertensive patients with high plasma renin levels suffer a higher incidence of vascular complications, the use of (3-blocking drugs would seem to be particularly beneficial to this class of patient (55). 

Rhetsinine (2), isolated from the hot water extract of Evodia rutae-carpa (family Rutaceae), was found to inhibit aldose reductase with an IC50 value of 24.1 /rM furthermore, the isolate inhibited sorbitol accumulation by 79.3% at 100 This compound could find potential use in the treatment of diabetic complications. Tetramethylpyrazine (3), one of the active components in Qing Huo Yi Hao, displayed strong antioxidant and endothelial protective effects, which can be comparable as Qing Huo Yi Hao this result indicated that some therapeutic potential of Qing Huo Yi Hao for vascular complications of diabetes may be attributed to the presence of tetramethylpyrazine (3). ... 

Toxicity/symptoms Peripheral nervous system (tingling in hands and feet), skin cancer (ingestion), lung cancer (inhalation) hyperpigmentation (keratosis) of palms and soles vascular complications... 

It is indicated in non-insulin dependent diabetes mellitus, diabetes with or without obesity in adults, diabetes in the elderly and diabetes with vascular complications. 

Schalkwijk CG, Stehouwer CD. Vascular complications in diabetes mellitus the role of endothelial dysfunction. Clin Sci. 2005 109 143-159. 

Yamagishi S, Imaizumi T. Diabetic vascular complications pathophysiology, biochemical basis and potential therapeutic strategy. Curr Pharm Des. 2005 11 2279-2299. 

There are a number of complications that arise as the result of poorly treated or unstabilized diabetes. Vascular Complications... 

The National Glycohemoglobin Standardization Program (NGSP) used the CRMLN model to establish a reference laboratory network to standardize glycated hemoglobin (i.e., HbAlc) [33, 34], The purpose of the NGSP is to standardize HbAlc so that clinical laboratory results are comparable to the Diabetes Control and Complications Trial (DCCT) where relationships were established to mean blood glucose and risk for vascular complications. 

Secondary endpoints MACE at 30 days + 1 year, vascular complications, TLR, TVF, TVR... 

Fadini GR Miorin M, Facco M, et al. Circulating endothelial progenitor cells are reduced in peripheral vascular complications of type 2 diabetes mellitus. J Am Coll Cardiol 2005 45 1449-1457. 

Role of Hyperglycemia and Redox-Induced Signaling in Vascular Complications of Diabetes... 

Fig. 9.1 Schematic model depicting the key events which mediate diabetes-associated vascular complications. Diabetes/hyperglycemia augments the levels of vasoactive peptides including Ang II/ET-1 that enhance the generation of reactive oxygen species (ROS). ROS-induced activation of growth-promoting signaling pathways, such as PKC and MAPK, contributes to aberrant vascular functions.

Inoguchi, T., and H. Nawata. 2005. NAD(P)H oxidase activation a potential target mechanism for diabetic vascular complications, progressive beta-cell dysfunction and metabolic syndrome. Curr. Drug Targets. 6 495-501. 

Most diabetics are in this category. Genetic factors rather than viruses or autoimmune antibodies are apparently causal. The metabolic alterations observed are milder than those described for IDDM (for example, NIDDM patients typically are not ketotic), but the long-term clinical consequences can be just as devastating (for example, vascular complications and subsequent infection can lead to amputation of the lower limbs). 

Because the dose of oestrogens and progestogens used in HRT products is low, the majority of women experience no adverse effects on liver function. Occasionally hepatic changes such as cholestatic jaundice, vascular complications and enlargement of haemangiomas have occurred. See the Clinical studies and Case reports sections below for further details. 

Valla and colleagues [17], in a case-control study of 33 women with BCS, identified a relative risk of 2.37 for this complication in users of oral contraceptives, a figure very close to that for other vascular complications of the pill. Current evidence suggests that oral contraceptives lead to hepatic vein thrombosis by exacerbating an underlying throm-bogenic condition [16]. 

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