Challenges in investigating Peripheral Vascular Disease in patients with Diabetes and Cardiovascular Diseases

Given the increasing prevalence of diabetes, with cardiovascular disease representing the principle cause of death and morbidity amongst diabetics, it is imperative that early investigation and then intervention is achieved. Diabetic patients are at increased risk of peripheral arterial disease (PAD), with an earlier onset and a more severe and diffuse manifestation often being seen. The key factors in diabetic arteriopathy include vascular smooth vessel dysfunction, inflammation, hypercoagulability and endothelial dysfunction. Moreover, the presence of PAD is a marker of generalised atherosclerosis and is a strong indicator of increased morbidity and mortality due to cardiovascular ischaemic events, with the risk of atherothrombotic events increasing in the presence of concomitant diabetes.