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Macrovascular disease in diabetes: current status
P Roesen1, P Ferber, D Tschoepe
1German Diabetes Research Institute, Heinrich Heine University, Duesseldorf, Germany.
Insights
Diabetes patients face serious macrovascular complications, leading to significant health burdens. Early detection and a multimodal therapeutic approach focusing on inflammation are crucial for better patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Pathophysiology
Background:
- Macrovascular complications significantly impact diabetes patient prognosis and contribute to the disease's socio-economic burden.
- Current morbidity and mortality rates suggest inadequate care for diabetes patients, possibly due to late diagnosis and unrecognised comorbidities.
- Endothelial dysfunction, termed "functional atherosclerosis," and blood hyperresponsiveness are key issues in diabetes progression.
Purpose of the Study:
- To explore novel experimental aspects of early atherosclerosis development in diabetes.
- To investigate the role of inflammation as a driving force in the evolution of complex diabetic lesions.
- To highlight the interconnectedness of inflammation, atherogenesis, and thrombogenesis via adhesion molecules.
Main Methods:
- Focus on experimental models of early atherosclerosis in diabetes.
- Analysis of the role of inflammation and adhesion molecules in disease progression.
- Discussion of genomic detection for risk identification and personalized drug targeting.
Main Results:
- Inflammation is identified as a key pathogenetic factor in early atherosclerosis in diabetes.
- Soluble and cellular adhesion molecules critically link inflammation, atherogenesis, and thrombogenesis.
- Genomic detection offers potential for early risk identification and tailored interventions.
Conclusions:
- A multimodal therapeutic strategy, tailored to individual patient needs and incorporating evidence-based interventions, is essential for reducing endpoints.
- Early identification of high-risk individuals through genomic detection can guide targeted drug interventions.
- Recognizing diabetes as a vascular disease necessitates a comprehensive approach to managing its complications.
Abstract:
Clearly, macrovascular complications are the prognosis limiting problem of diabetes patients which consecutively account for the majority of socio-economic burden of the disease. The overall morbidity and mortality development does not indicate improvement hallmarking better or at least adequate care for these patients. Possible explanations address the late detection problem of a clinically silent disease onset as well as unrecognised multiple comorbid conditions all of which end-up with endothelial dysfunction as representation of the so called "functional atherosclerosis" and blood hyperresponsiveness. Here, we describe new experimental aspects of the early atherosclerosis development focussing inflammation as one driving pathogenetic force for the evolution of the complicated lesion type in diabetes. However, emphasis is put on the view that inflammation, atherogenesis and thrombogenesis are severely crosslinked by soluble and cellular adhesion molecules. From a diagnostic point of view genomic detection of risk associated genes opens both the vision of early identification of high risk individuals and the targeting of drug intervention based on conditioned responsiveness. By using available drugs and evidence based risk factor intervention strategies a plea is made for a multimodal therapeutic approach fitted to the individual patient's needs aiming at endpoint reduction. This corresponds to the recent releases of guidelines from nearly all vascular medicine related scientific societies. Diabetes is a vascular disease!