Peripheral and cerebrovascular atherosclerotic disease in diabetes mellitus

Diabetes mellitus is frequently associated with atherosclerotic vascular disease involving the coronary, peripheral and cerebrovascular circulation. Compared with non-diabetic counterparts, peripheral arterial disease (PAD) in diabetic individuals is more diffuse and often involves the popliteal and below-knee arteries. The goal of treatment in diabetic patients with PAD, as in other patients with this condition, is to aggressively treat atherosclerotic risk factors to reduce future cardiovascular events as well as to improve symptoms of claudication and prevent limb amputation. Diabetes is also associated with a heightened risk of stroke which is a common cause of morbidity and mortality in diabetic individuals. Optimal blood pressure control is paramount in reducing the future risk of stroke in these patients. Clinicians need to be aware of the strong association between diabetes and non-coronary atherosclerosis and use appropriate medical and interventional treatments to reduce the associated disability and mortality in these patients.