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Cardio Diabetes Medicine 2017 Diabetes and Heart Are Inseparable Partners - How & Why 75
↓ Nitric oxide production ↑ Activity of protein kinase C
↓ Prostacyclin bioavailability ↑ AGEs and AGE-RAGE interactions
↑ Endothelin 1 activity Even then the pernicious effects of hypoglycemic
episodes which occur as a risk of diabetic manage-
↑ Angiotensin II activity
ment, the sympathovagal imbalance due to diabetic
↑ Cyclooxygenase type 2 (COX-2) activity autonomic neuropathy, and the vascular effects of
constitutive exposure to excess insulin may further
↑ Thromboxane A2 activity
contribute to atherosclerotic risk. Perturbations in the
↑ Reactive oxygen species coagulation and fibrinolytic pathways and in platelet
↑ Lipid peroxidation products biology add to the vascular risk of diabetes, yield-
ing a constitutive prothrombotic milieu. In addition,
↓ Endothelium-dependent relaxation disturbances of platelet activation, aggregation, mor-
↑ Receptor for advanced end glycation products phology, and lifespan further contribute to increased
(RAGE) expression thrombotic potential, as well as to the acceleration of
atherosclerosis.
Vascular smooth muscle cells and vascular matrix
↑ Proliferation and migration into intima Prevention of atherosclerotic coronary
vascular disease:
↑ Increased matrix degradation
Therapeutic lifestyle interventions remain the cor-
Inflammation
nerstone of prevention of the atherosclerotic com-
↑ IL-1β, IL-6, CD36, Monocyte Chemoattractant pro- plications associated with diabetes like smoking ab-
tein (MCP-1) stinence, at least 150 minutes of moderate-intensity
aerobic activity weekly, and nutrition recommenda-
↑ Adhesion molecules and selectins
tions for weight control with dietary composition and
Cardio Diabetes Medicine
