Coronary artery disease in diabetic patients with nephropathy

Patients with juvenile-onset, insulin-dependent diabetes mellitus (IDDM) are at high risk of premature coronary artery disease. The risk is concentrated in diabetic patients who develop nephropathy. Synergy in atherogenesis is likely to be present between hyperglycemia and the metabolic alterations of diabetic nephropathy, which include hypertension, hypercholesterolemia, and high lipoprotein (a) levels. The accumulation of advanced glycation end-products in blood vessel walls and on lipoproteins may result in increased vascular permeability and uptake of cholesterol, particularly in the setting of hypertension and hypercholesterolemia. The net result may be acceleration of atherogenesis.