The cause of diabetes mellitus is metabolic in origin. However, its major clinical manifestations, which result in most of the morbidity and mortality, are a result of its vascular pathology. In fact, the American Heart Association has recently stated that, ¿from the point of view of cardiovascular medicine, it may be appropriate to say, diabetes is a cardiovascular disease¿ (1). But diabetic vascular disease is not limited to just the macrovasculature. Diabetes mellitus also affects the microcirculation with devastating results, including nephropathy, neuropathy, and retinopathy. Diabetic nephropathy is the leading cause of end-stage renal disease in the United States, while diabetic retinopathy is the leading cause of new-onset blindness in working-age Americans. The importance of this text on Diabetes and Cardiovascular Disease is evident by the magnitude of the population affected by diabetes mellitus. Over 10 million Americans have been diagnosed with diabetes mellitus, while another 5 million remain undiagnosed. The impact from a public health perspective is huge and increasing. As the population of the United States grows older, more sedentary, and obese, the risk of developing diabetes and its complications will increase. Epidemiological studies have identified diabetes mellitus as a major independent risk factor for cardiovascular disease. Over 65% of patients with diabetes mellitus die from a cardiovascular cause. The prognosis of patients with diabetes mellitus who develop overt clinical cardiovascular disease is much worse than those cardiovascular patients free of diabetes mellitus.

Pathophysiology.- Effects of Insulin on the Vascular System.- Effects of Diabetes and Insulin Resistance on Endothelial Functions.- Diabetes and Advanced Glycoxidation End-Products.- The Renin-Angiotensin System in Diabetic Cardiovascular Complications.- PPARs and Their Emerging Role in Vascular Biology, Inflammation, and Atherosclerosis.- Diabetes and Thrombosis.- Role of Estrogens in Vascular Disease in Diabetes.- Poly(ADP-Ribose) Polymerase Activation and Nitrosative Stress in the Development of Cardiovascular Disease in Diabetes.- Adiponectin and the Cardiovascular System.- Nitric Oxide and Its Role in Diabetes Mellitus.- Diabetes and Atherosclerosis.- The Use of Animal Models to Study Diabetes and Atherosclerosis and Potential Anti-Atherosclerotic Therapies.- Clinical.- The Metabolic Syndrome and Vascular Disease.- Diabetes and Hypertension.- Diabetes and Dyslipidemia.- Diabetic Retinopathy.- Diabetic Nephropathy.- Diabetic Neuropathy.- Microcirculation of the Diabetic Foot.- Epidemiology of Peripheral Vascular Disease.- Noninvasive Methods to Assess Vascular Function and Pathophysiology.- Peripheral Vascular Disease in Patients With Diabetes Mellitus.- Therapeutic Interventions to Improve Endothelial Function in Diabetes.- Preoperative Assessment and Perioperative Management of the Surgical Patient With Diabetes Mellitus.- Diabetes and Percutaneous Interventional Therapy.- Cardiac Surgery and Diabetes Mellitus.- Heart Failure and Cardiac Dysfunction in Diabetes.- Diabetes Mellitus and Heart Disease.