Review article
Diabetic microangiopathy – a current look at the pathogenesis and the clinical implications for cardiovascular diseases

Microangiopathy is one of the chronic complications in patients with diabetes mellitus. Morphological and functional changes in vessels below 100 nm are typical for diabetic microangiopathy. There are many genetic, biochemical and haemodynamic factors causing microangiopathy. The most important clinical changes happen in the retina (retinopathy), kidneys (nephropathy), nervous system (neuropathy) and in the heart (cardiomyopathy). Diabetic microangiopathy and macroangiopathy (atherosclerosis) in coronary arteries and arteries of the upper and lower limbs have a direct influence on life quality and long-term prognosis. In patients with higher HBA1c level there is a higher risk of microvascular complications than risk of myocardial infarction. Low exercise tolerance and symptoms of heart failure directly correlate with progression of microangiopathy. It makes diagnosis of ischaemic heart disease and heart failure in patients with DM much more difficult. Early treatment of the most important cardiovascular risk factors reduces future complications caused by microangiopathy.