In the diabetic vascular complication, biochemical and mechanical injuries to endothelial cells are involved not only in the process of microangiopathy, but also in diabetic atherosclerosis (or arteriosclerosis) which is so-called macroangiopathy. In the presence of diabetes or persistent hyperglycemia, many cytokines including growth factors such as PDGF, HB-EGF, IL-1 beta and TNF alpha are upregulated in intimal cells of the arterial or aortic wall. These changes alter the cytokine network in the common mechanism of atherosclerosis, "Response-to-injury hypothesis", and further accelerate the formation of atherosclerotic lesion. In addition, diabetes causes abnormal responsibility to HB-EGF, PDGF and TGF-beta in medial smooth muscle cells leading to the elevated activity to their proliferation and migration into the intima. Thus, all cell types consisting arterial or aortic wall are involved in the process of diabetic atherosclerosis.