High blood sugar and smoking damage the arterial glycocalyx, impairing its ability to prevent blood clots.

“one of the things that damages the glycocalyx is high blood sugar level so the glycocalyx is a lipid protein frond within which have contained anticoagulants nitric oxide synthase etc etc so your glycocalyx is really really important if you damaging like you can extend the cilia cells are then exposed to the blood and all the nasty things that are potentially in the blood and this is where you get secondary damage”