Macrovascular complications of diabetes can have long-term effects on different parts of the body. They include high blood pressure, arterial stiffness, and kidney disease.

Macrovascular disease affects the large blood vessels, including the coronary arteries, the aorta, and the large arteries in the brain and limbs. Some may appear soon after diagnosis, while others may take several years to develop.

In this article, we look at the macrovascular complications of diabetes and why they occur, as well as tips for managing and preventing them.

Additionally, we outline the difference between macrovascular and microvascular complications.

Macrovascular complications of diabetes can lead to:

If a person does not receive treatment, these complications can lead to heart failure and, ultimately, death. According to the Centers for Disease Control and Prevention (CDC), 1 person in the United States dies from cardiovascular disease every 34 seconds.

Early macrovascular disease happens as a result of a buildup of fatty substances, or plaque, which narrows or blocks the blood vessels that supply blood and oxygen to the heart, the brain, and the rest of the body. This is known as stenosis.

Plaque can also rupture, causing blood clots, which can lead to thrombosis, embolism, hemorrhaging, and atherosclerosis.

As the condition worsens, the blood vessels become completely obstructed. These obstructions increase the risk of heart attacks, strokes, claudication, cramping of the limbs, and gangrene.

Macrovascular complications do not appear to differ between type 1 and type 2 diabetes.

They include:

  • Hyperglycemia: A small 2019 study involving 20 older adults with impaired glucose tolerance suggests a link among hyperglycemia, arterial stiffness, and endothelial dysfunction. This happens as a result of a lack of nitric oxide gas inside blood vessel walls, which causes the arteries to narrow, slowing down the blood flow.
  • Hypertension: A 2018 review mentions a link between hypertension and arterial stiffness.
  • Dyslipidemia: A large 2020 cohort study involving 8,698 men and women suggests that an imbalance of lipids can lead to cardiovascular disease.
  • Diabetic kidney disease: Evidence suggests that diabetic kidney disease can lead to kidney failure.

People can manage these complications in various ways, including:

  • Blood sugar management: People can monitor their blood sugar levels to reduce the risk of microvascular and macrovascular complications.
  • Laser therapy: People who have diabetes with retinopathy may opt for this therapy in order to prevent future blindness.
  • Screening: People may opt for screening to monitor progress or regression.
  • Medication: Doctors can offer angiotensin-converting enzymes such as ramipril, statins, and metformin to help people with high blood pressure.

People may be able to prevent or delay complications that arise from diabetes by taking the following actions:

  • Managing blood sugar, blood pressure, and blood fat levels: People can do this by taking part in regular health checks.
  • Managing diabetes: People should keep blood sugar levels within moderate limits to reduce the risk of complications.
  • Seeking support to quit smoking: Stopping smoking increases blood flow around the body, especially in the heart and feet.
  • Maintaining a nutritious diet: Eating plenty of fresh fruits and vegetables and fewer highly processed foods can help people bring down HbA1c levels, manage blood pressure, and reduce cholesterol levels.
  • Staying physically active: Exercise can help lower blood pressure, blood cholesterol, and blood sugar levels.

Both macrovascular and microvascular diseases are complications of type 1 and type 2 diabetes, and the two types of complications have similar risk factors.

Macrovascular disease affects large blood vessels, whereas microvascular disease affects smaller blood vessels, such as the capillaries.

Microvascular disease can lead to conditions such as retinopathy and neuropathy.

The presence of microvascular disease can also increase the risk of heart disease and death in people with type 2 diabetes, regardless of whether macrovascular disease is present at the same time. Additionally, people with microvascular disease may be more likely to develop macrovascular disease in the future.

Microvascular disease has links to chronic hyperglycemia, but it remains unclear whether hyperglycemia causes macrovascular disease.

Macrovascular disease affects the large blood vessels. The cause is a buildup of plaque, which obstructs and sometimes blocks the blood vessels that deliver oxygen and blood to the heart, the brain, and the rest of the body.

Microvascular disease affects the small blood vessels. As in macrovascular disease, plaque builds up and can obstruct the blood vessels. Both macrovascular disease and microvascular disease are present in type 1 and type 2 diabetes — however, the two conditions have different risk factors.

People who have type 1 or type 2 diabetes can manage and prevent both macrovascular and microvascular disease to improve their quality of life.