Cardiovascular complications of diabetes

ABSTRACT

Introduction

Type 2 diabetes mellitus (T2DM) is the ninth leading cause of mortality globally, and the prevalence continues to rise. Among individuals with T2DM, over two-thirds of deaths are caused by the cardiovascular complications of diabetes. These complications include atherosclerosis, coronary artery disease, nephropathy, stroke, thromboembolism, peripheral vascular disease. They have been long studied, and there are several theories as to the pathophysiology of how diabetes leads to these complications. The least understood mechanism is the pathophysiology linking diabetes to heart failure.

Areas covered

This review focuses on the mechanisms of how T2DM leads to the aforementioned complications, particularly highlighting the development of heart failure. An extensive literature review of novel therapeutic options targeting the cardiovascular effects of T2DM was completed and summarized in this review.

Expert opinion

This review finds that most studies to date have focused on the atherosclerotic vascular complications of diabetes. The pathophysiology between T2DM and heart failure is even less understood. Currently therapies that aim to decrease the risk of heart failure in diabetes are sparse. More research is required in order to better understand the changes at a cellular level and subsequently help providers to choose therapeutics that better target cardiovascular complications.

KEYWORDS:

• Endothelial dysfunction
• heart failure
• pentoxifylline
• reactive oxygen species (ROS)
• GLP-1 agonists
• SGLT-2 inhibitors
• type 2 diabetes mellitus

Article highlights

• Diabetes has both micro-vascular and macro-vascular effects leading to several complications such as accelerated atherogenesis, stroke, nephropathy, prothrombotic state, and heart failure.

• It has been suggested that the pathophysiological link between diabetes and heart failure may be caused by several different mechanisms such as triglyceride deposition, collagen deposition, fibrosis, direct stimulation of hypertrophy, and deposition of advanced glycation end products.

• It has been established that certain medications for diabetes improve cardiac and renal function, however the mechanism of these benefits is still not completely understood.

• The future of diabetes treatment should focus not only on improving glucose control but also on preventing and treating the cardiovascular complications of diabetes.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.