Macrovascular diabetes complications

Macrovascular diabetes complications are diseases and conditions of the large blood vessels caused by diabetes. These complications can occur in blood vessels in any part of the body.

Factors that contribute to macrovascular complications are high blood sugar, high insulin levels, high cholesterol, high blood pressure, smoking, and abnormalities in blood clotting.

Doctors do not understand what causes some people to develop diabetes complications while others do not. Some people may have tissue and unidentified factors that are resistant to damage. Lifestyle and inherited factors may also affect the risk for developing complication. For example, if you smoke, you are at higher risk for developing heart and blood vessel disease than someone who does not smoke.

Macrovascular diabetes complications include heart disease, stroke, and peripheral arterial disease.

Heart disease

People with diabetes are at risk for heart attack and other heart problems:¹

• Heart disease causes about 70% of the deaths in people with diabetes.
• The risk of dying from heart disease for men with diabetes is 2 to 3 times greater and for women with diabetes 3 to 4 times greater than for people without diabetes.
• People with diabetes who have had a heart problem (such as a heart attack) are 2 to 3 times more likely to have another heart problem than people with diabetes who have not had a prior problem.
• People with diabetes who have very small amounts of protein in their urine (microalbuminuria) are twice as likely to have a heart problem, such as heart attack, than people with diabetes who do not have protein in their urine.

If you have diabetic neuropathy, especially if it affects the internal organs (autonomic neuropathy), you may not have heart-related symptoms or may have symptoms that are not typical of heart problems. As a result, you may not seek medical help early enough to prevent serious problems or even death. This is the reason that you need to see your doctor regularly and have the monitoring tests according to the recommended schedule.

Stroke

People with diabetes are 2 to 4 times more likely to have a stroke than people who do not have diabetes.²Plaque buildup and clot formation cause blockage in the blood vessels leading to the brain. People with diabetes often have high blood pressure, which can cause abnormalities in the small blood vessels of the brain and lead to stroke.

Peripheral arterial disease

People with diabetes are at risk for narrowing of the large vessels of their legs. The resulting poor circulation impairs healing and means that even a minor injury or infection can develop into a serious infection. If you have peripheral diabetic neuropathy, you are at increased risk for injury to your feet and legs. A serious foot infection may travel up your leg, infect the bones, and may lead to an amputation.

Macrovascular complications and their symptoms

Complication	Symptoms
Heart disease	Chest pain. If you have autonomic diabetic neuropathy, you may not have chest pain. Decreased tolerance for physical activity Chronic fatigue Shortness of breath Swelling of the legs and ankles Palpitations
Stroke	Impaired speech Inability to see in one eye or double vision Inability to walk Paralysis on one side of the body Numbness or tingling
Peripheral arterial disease	Pain in the calves when walking Coolness of the lower extremities Loss of hair on the legs Ulcers on the legs that do not heal promptly Pain in the feet when resting
Impaired immune system functioning	Frequent infections, sometimes with unusual types of bacteria and fungus Poor wound healing
Impaired processing of cholesterol	Buildup of plaque in blood vessels, which contributes to increased frequency of heart disease, stroke, and circulation problems

Citations

1. Gerstein HC, et al. (2001). Cardiovascular disease. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 488–514. Hamilton, ON: BC Decker.

2. American Diabetes Association (2004). Aspirin therapy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S72–S73.