In Vitro and Clinical Investigations in Lower Extremity Artery Disease with a Special Focus on Diabetes Mellitus
Abstract
Peripheral arterial disease (PAD) is the third leading cause of atherosclerotic cardiovascular
morbidity, following coronary and cerebrovascular diseases. More than 200 million people
suffer from PAD worldwide, of whom nearly 40 million live in Europe. At least 50% of all
PAD patients are asymptomatic. The symptomatic disease is only the tip of the iceberg, most
patients are asymptomatic due to walking disabilities, e.g. heart disease, musculoskeletal
disorders or reduced pain sensitivity caused by diabetic polyneuropathy. The main risk factors
include smoking, diabetes mellitus (DM), hypertension, age. In patients with diabetes, LEAD
is associated with earlier large vessel involvement and atherosclerosis affects mostly the distal
arteries, and causes distal symmetrical neuropathy. The incidence of critical limb ischemia is
10 to 20 times higher in patients with DM, moreover they have a 5-fold higher risk of
amputation. The Framingham Study and other epidemiological investigations, have reported
that besides conventional cardiovascular risk factors, hemorheological parameters are primary
and independent cardiovascular risk factors e.g. hematocrit, fibrinogen and viscosity. Several
clinical studies have described an association between hemorheological parameters and macroor
microangiopathies in diabetes. These hemorheological alterations may have a remarkable
effect on the whole vascular system causing development of wide range of cardio-,
cerebrovascular and peripheral arterial diseases. The alterations of hemorheological parameters
in diabetes mellitus and peripheral arterial disease have been described by several studies,
which can be considered as potential risk factors of cardiovascular diseases. Impairment of
these factors may have a role in tissue hypoperfusion and disturbances of microcirculation.