This was written originally in 2009 early days of this blog. Now, re-posting it in 2021 , wonder any one has new data on this!
We know diabetes, smoking, hyperlidemia, hypertension are major risk factors for progressive vascular disease. They damage the vascular endothelium either directly or indirectly , by aggravating the atheroscelortic process . Diabetes apart from affecting the medium sized arteries , also affect the microvasculature. Smoking has a direct effect on endothelial function .It depletes vascular nitric oxide. High levels of circulating lipids injures the sub endothelial structures and invades the media by entering macrophages .So , all these 4 risk factors either operate independently or interact with each other and result in progressive vascular disease.
While we believe , these risk factors do not have any bias in attacking the human vascular tree, in the real world it is observed they have their own behavior pattern and have unique predilection and a deadly alliance .
For example , in chronic smokers TAO is the commonest manifestation , thrombo angitis is far too less common to occur in the coronary arteries.
Similarly hypertension per se rarely results in an acute coronary syndrome while it is the single important cause for cerebro vascular disease. Diabetes especially in women has very strong predilection for CAD , while diabetic per se is a lesser risk for stroke. Hyperlipedimia may be the one which has fairly even risk throughout the vasculature. Similarly there is a difference in renal and carotid arterial involvement with reference to the conventional risk factors .
Why this apparent difference ?
We are unlikely to get an answer to this question in the near future . Left to the youngsters . . . of tomorrow !
* Note of clarification
The source for the above chart is collected from various studies and also a huge observational data from our hospital. There could be some geographical variation , a given individual may respond differently to these risk factor depending upon his genetic predisposition and susceptibility . So the above data can be applied to general population and not to a individual.
Dr.S.Venkatesan MD 