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.