The cardiovascular complications in diabetic patients are considered the most important cause of death. The physiopathological mechanisms of accelerated atherosclerotic process are related to hyperglicemia, dyslipidemia and insulin resistance. Hyperglicemia stimulates protein oxidation (AGEs formation) and lipid peroxidation. These reactions may stimulate the citokines production and the development of endothelium dysfunction with impairment of oxide nitric release. Peptides as angiotensin and endothelin may promote vasoconstiction. There are impairment of fibrinolysis with increase in PAI-1 levels and changes in others coagulation factors, as von Willebrand factor and increase of platelets aggregation. These mechanisms are related to accelerated atherosclerotic vascular process observed in diabetic patients.
Myocardial dysfunction have been related to: morphologic myocardial pattern, calcium homeostasis, glucose and free fatty acids metabolism, coronary blood flow, contractiles proteins, and autonomic dysfunction. The cohexitence of these factors may devellop the diabetic cardiomyopathy. The knowledge of these pathogenic mechanisms is very important to choose the best therapy and reduce the mobidity and mortality of these patients.