Does Microvascular Dysfunction Promote Atherosclerosis?
Among patients with diabetes, it is well accepted that small and large vessel disease frequently coexist. This has been amply documented in large observational studies, for example that of Pirart [10] and interventional clinical trials such as the United Kingdom Prospective Diabetes Study (UKPDS) [11]. Vascular complications often develop in multiple tissues in a complex web wherein one complication can promote the development and/or progression of others [12]. The close and often catastrophic association between diabetic nephropathy and atherosclerosis is perhaps the best-known example of this kind of interaction between small and large vessel disease. Thus, a high proportion of patients with progressive renal disease arising as a consequence of diabetic nephropathy succumb to fatal macrovascular events, usually myocardial infarction and its sequelae, well before they reach end-stage renal failure [13]. In turn, nephropathy-associated hypertension accelerates the loss of glomerular fu
