Diabetes Mellitus and Noncardiac Atherosclerotic Vascular Disease—Pathogenesis and Pharmacological Treatment Options

Abstract

Diabetes mellitus (DM) is also a cause of cardiovascular (CV) disease (CVD). Addressing the atherosclerotic CVD (ASCVD) burden in DM should reduce premature death and improve quality of life. Diabetes mellitus–associated ASCVD can lead to complications in all vascular beds (carotids as well as coronary, lower extremity, and renal arteries). This narrative review considers the diagnosis and pharmacological treatment of noncardiac atherosclerotic vascular disease (mainly in patients with DM). Based on current knowledge and the fact that modern DM treatment guidelines are based on CV outcome trials, it should be noted that patients with noncardiac CVD may not have the same benefits from certain drugs compared with patients who predominantly have cardiac complications. This leads to the conclusion that in the future, consideration should be given to conducting well-designed trials that will answer which pharmacological treatment modalities will be of greatest benefit to patients with noncardiac ASCVD.

Re: Iglay K, Hannachi H, Engel SS, et al. Comorbidities in type 2 diabetes patients with and without atherosclerotic cardiovascular disease: a retrospective database analysis. Curr Med Res Opin. 2021. DOI:10.1080/03007995.2021.1895736

“…Duration of DM also increases the risk of CHD death independently of coexisting risk factors (RFs) [3] and ASCVD affects approximately 32.2% of all T2DM patients [4]. Addressing the ASCVD burden in DM should improve quality of life and reduce premature death [5].…”

A Randomized Controlled Trial Evaluating Outcome Impact of Cilostazol in Patients with Coronary Artery Disease or at a High Risk of Cardiovascular Disease

“…When it comes to atherosclerotic CV disease, we should pay more attention to diabetic mellitus (DM), since DM is an important risk factor of atherosclerotic CV diseases, including CAD and other non-cardiac atherosclerotic diseases. Pharmacological treatment for this group of patients is of great interest, and tailored therapies are needed [ 24 ]. A recent review demonstrated that cilostazol might help to reduce diabetes-associated microvascular complications [ 25 ], but studies using cilostazol in patients with DM for macrovascular events were lacking.…”

Influence of Carotid Intima-Media Thickness Levels at Bifurcation on Short-Term Functional Outcomes Among Non-Cardiogenic Ischemic Stroke Patients with and without Type 2 Diabetes Mellitus

“… 10 Vascular endothelial dysfunction also occurs in type 2 diabetes mellitus (T2DM) at early stage and triggers consecutive systemic inflammation. 11 These subtle pathological changes gradually contribute to vascular complications such as IMT, atherosclerosis and increase the risk of poor prognosis in stroke. 12 , 13 …”