| Preface | 6 |
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| Contents | 8 |
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| Contributors | 10 |
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| Color Plates | 12 |
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| Hormonal Regulation of the Vascular System: An Overview | 13 |
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| INTRODUCTION | 13 |
| ESTROGEN | 18 |
| PROGESTERONE | 19 |
| ANDROGENS | 19 |
| CONCLUSION | 21 |
| REFERENCES | 21 |
| I DIABETES AND CARDIOVASCULAR DISEASE | 29 |
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| Epidemiology and Prevention of Cardiovascular Disease in Diabetes | 31 |
| PREVALENCE OF DIABETES | 32 |
| IMPACT OF DIABETES ON HEALTH AND HEALTHCARE COSTS | 32 |
| DIABETES AS A RISK FACTOR FOR CORONARY ARTERY DISEASE | 33 |
| OUTCOME AMONG DIABETES PATIENTS WITH CORONARY ARTERY DISEASE | 34 |
| DIABETES AS A RISK FACTOR FOR HEART FAILURE | 34 |
| OUTCOMES AMONG DIABETES PATIENTS WITH HEART FAILURE | 34 |
| SECONDARY PREVENTION OF CARDIOVASCULAR DISEASE IN DIABETES – BLOOD PRESSURE CONTROL | 34 |
| SECONDARY PREVENTION OF CARDIOVASCULAR DISEASE IN DIABETES – LIPID CONTROL | 37 |
| SECONDARY PREVENTION OF CARDIOVASCULAR DISEASE IN DIABETES – GLYCEMIC CONTROL | 40 |
| SECONDARY PREVENTION OF CARDIOVASCULAR DISEASE IN DIABETES – SMOKING CESSATION | 41 |
| SUMMARY | 42 |
| ACKNOWLEDGMENTS | 42 |
| REFERENCES | 42 |
| Disruption of the Nitric Oxide Signaling System in Diabetes | 47 |
| INTRODUCTION | 48 |
| VASCULAR ENDOTHELIUM | 49 |
| NO SYNTHASE/SOLUBLE GUANYLATE CYCLASE/CYCLIC GMP- DEPENDENT PATHWAY | 49 |
| ENDOTHELIAL DYSFUNCTION | 50 |
| INFLUENCES OF DIABETES ON THE VASCULAR WALL | 50 |
| NITROSATIVE STRESS STATE | 56 |
| MITOCHONDRIA | 57 |
| CONCLUSION | 60 |
| REFERENCES | 61 |
| Free Fatty Acids, A Major Link Between Obesity, Insulin Resistance, Inflammation, and Atherosclerotic Vascular Disease | 73 |
| INTRODUCTION | 74 |
| FFA AND INSULIN RESISTANCE | 75 |
| MECHANISM FOR FFA-INDUCED INSULIN RESISTANCE | 76 |
| FFA AND INFLAMMATION | 77 |
| BLOOD COAGULATION/FIBRINOLYSIS | 78 |
| FFA AND LIPOPROTEINS | 79 |
| ACKNOWLEDGMENTS | 80 |
| REFERENCES | 80 |
| The Anti-Inflammatory and Antiatherogenic Effects of Insulin | 83 |
| ANTI-INFLAMMATORY EFFECTS OF INSULIN | 84 |
| ANTIATHEROGENIC EFFECT OF INSULIN | 86 |
| PROINFLAMMATORY EFFECTS OF GLUCOSE AND OTHER MACRONUTRIENTS | 86 |
| CLINICAL IMPLICATIONS | 87 |
| REFERENCES | 89 |
| Insulin Sensitizers and Cardiovascular Disease | 93 |
| INTRODUCTION | 94 |
| EFFECTS OF INSULIN SENSITIZERS ON LIPID METABOLISM | 95 |
| INSULIN SENSITIZERS AND HYPERTENSION | 95 |
| ROLE OF INSULIN SENSITIZERS IN ENDOTHELIAL FUNCTION AND VASCULAR REACTIVITY | 96 |
| INSULIN SENSITIZERS AND VASCULAR WALL ABNORMALITIES | 98 |
| INSULIN SENSITIZERS AND FIBRINOLYSIS AND COAGULATION | 98 |
| INSULIN SENSITIZERS AND ALBUMINURIA | 99 |
| EFFECT OF INSULIN SENSITIZERS ON CONGESTIVE HEART FAILURE, LEFT VENTRICULAR MASS, AND TYPE 2 DIABETES | 99 |
| OUTCOME STUDIES FOR PREVENTION OF MACROVASCULAR COMPLICATIONS IN TYPE 2 DM | 100 |
| ONGOING STUDIES | 102 |
| CONCLUSION | 103 |
| ACKNOWLEDGMENTS | 103 |
| REFERENCES | 103 |
| Screening for Cardiovascular Disease in Symptomatic and Asymptomatic Patients with Diabetes Mellitus | 109 |
| CORONARY ARTERY DISEASE IN DIABETES MELLITUS | 110 |
| STRESS ECHOCARDIOGRAPHY | 110 |
| NUCLEAR STRESS MYOCARDIAL PERFUSION IMAGING | 114 |
| COMPUTED TOMOGRAPHY FOR CORONARY ARTERY CALCIUM SCREENING | 120 |
| CURRENT RECOMMENDATIONS | 124 |
| CONCLUSIONS | 125 |
| REFERENCES | 126 |
| II ENDOCRINE HYPERTENSION AND CARDIOVASCULAR EVENTS | 131 |
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| Renin-Angiotensin System | 133 |
| RENIN-ANGIOTENSIN SYSTEM | 134 |
| THE CIRCULATING AND TISSUE RAS | 135 |
| RENIN | 135 |
| ANGIOTENSINOGEN | 136 |
| ENZYMES IN THE RAS | 137 |
| ANGIOTENSIN PEPTIDES: THEIR ACTION, FORMATION, AND DEGRADATION ( FIG. 1) | 141 |
| ANGIOTENSIN RECEPTORS | 142 |
| TISSUE RAS | 144
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