Macrovascular diabetes complications

Macrovascular diabetes complications are diseases and conditions of the large blood vessels caused by diabetes. These complications can occur in blood vessels in any part of the body.

Factors that contribute to macrovascular complications are high blood sugar, high insulin levels, high cholesterol, high blood pressure, smoking, and abnormalities in blood clotting.

Doctors do not understand what causes some people to develop diabetes complications while others do not. Some people may have tissue and unidentified factors that are resistant to damage. Lifestyle and inherited factors may also affect the risk for complications. For example, if you smoke, you are at higher risk for heart and blood vessel disease than someone who does not smoke.

Macrovascular diabetes complications include heart disease, stroke, and peripheral arterial disease.

Heart disease

People with diabetes are at risk for heart attack and other heart problems:1

  • Heart disease and stroke cause about 65% of the deaths in people with diabetes.
  • The risk of dying from heart disease for adults who have diabetes is 2 to 4 times greater than for people who do not have diabetes.
  • The risk of having a stroke is 2 to 4 times higher for people who have diabetes.

If you have diabetic neuropathy, especially if it affects the internal organs (autonomic neuropathy), you may not have heart-related symptoms or may have symptoms that are not typical of heart problems. As a result, you may not seek medical help early enough to prevent serious problems or even death. Be sure to seek care very early, even if your symptoms are not serious and even if you think your symptoms are not related to your heart.


People with diabetes are 2 to 4 times more likely to have a stroke than people who do not have diabetes.2Plaque buildup and clot formation cause blockage in the blood vessels leading to the brain. People with diabetes often have high blood pressure, which can cause abnormalities in the small blood vessels of the brain and lead to stroke.

Peripheral arterial disease

People with diabetes are at risk for narrowing of the large vessels of their legs. The resulting poor circulation impairs healing and means that even a minor injury or infection can develop into a serious infection. If you have peripheral diabetic neuropathy, you are at increased risk for injury to your feet and legs. A serious foot infection may travel up your leg, infect the bones, and may lead to an amputation.

Macrovascular complications and their symptoms



Heart disease
  • Chest pain. If you have autonomic diabetic neuropathy, you may not have chest pain.
  • Decreased tolerance for physical activity
  • Chronic fatigue
  • Shortness of breath
  • Swelling of the legs and ankles
  • Palpitations
  • Impaired speech
  • Inability to see in one eye or double vision
  • Inability to walk
  • Paralysis on one side of the body
  • Numbness or tingling
Peripheral arterial disease
  • Pain in the calves when walking
  • Coolness of the lower extremities
  • Loss of hair on the legs
  • Ulcers on the legs that do not heal promptly
  • Pain in the feet when resting


  1. American Diabetes Association (accessed April 7, 2009). Complications of diabetes in the United States. Available online:
  2. American Diabetes Association (2004). Aspirin therapy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S72–S73.

Last Updated: August 8, 2009

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