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[Myocardial and coronary vessel dysfunction in diabetes I patients]
Ewa Konduracka1, Danuta Galicka-Latała, Wiesława Piwowarska
1Klinika Choroby Wieńcowej Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie.
Insights
Diabetic patients face high cardiovascular risks due to heart dysfunction and accelerated atherosclerosis. Even with improved glycemic control, the elevated risk of coronary artery disease persists in type 1 diabetes.
Area of Science:
- Cardiology
- Endocrinology
- Pathophysiology
Context:
- Cardiovascular complications remain the leading cause of mortality in diabetic patients despite advances in diagnosis and treatment.
- Diabetes mellitus adversely affects myocardial and coronary vessel function through macroangiopathy, microangiopathy, metabolic disturbances, and autonomic neuropathy.
Purpose:
- To explore the multifaceted impact of diabetes on cardiovascular health.
- To investigate the contributing factors to accelerated atherosclerosis and coronary artery disease in diabetic populations, particularly type 1 diabetes.
- To highlight the complexities in preventing and treating cardiovascular complications in diabetic patients.
Summary:
- Diabetes-induced macroangiopathy leads to accelerated atherosclerosis, observable in type 1 diabetes patients by age 30.
- Additional risk factors beyond traditional atherosclerosis contributors include hyperglycemia, protein glycation/glycoxidation, altered lipoproteins, microalbuminuria, and coagulation/fibrinolytic disturbances.
- These factors contribute to endothelial dysfunction and heightened atherosclerosis risk, complicating cardiovascular disease management.
Impact:
- Understanding these mechanisms is crucial for developing targeted strategies to mitigate cardiovascular risk in diabetic individuals.
- Improved glycemic control alone may not sufficiently reduce the elevated risk of coronary artery disease in type 1 diabetes.
- This research underscores the need for comprehensive management approaches addressing the complex interplay of factors contributing to diabetic cardiovascular complications.
Abstract:
Despite of dramatic improvement in diagnostic procedures and treatment of diabetic patients, cardio-vascular complications are still the most frequent causes of death in these patients. Diabetes influences myocardial and coronary vessels function by coexisting macroangiopathy, microangiopathy, metabolic disturbances and autonomic nervous system neuropathy. All these factors result in diastolic and systolic dysfunction of the heart. Cardiomyopathy, congestive heart failure and serious arrhythmias are the end stage of diabetic complications. Macroangiopathy demonstrates accelerated atherosclerosis (involving coronary arteries), which consequences can be observed in 1 type diabetes patients at around the age of 30. Causes of increased risk of macroangiopathy in type 1 diabetic patients are not clear. There are not many clinical, prospective trials which can allow for etiology determination of the increased incidence of atherosclerosis and mortality due to coronary artery disease in this population. Adding to traditional risk factors of atherosclerosis like genetic factors, hypertension, dyslipidemia, obesity, smoking and improper diet, other important risk factors are observed in diabetic patients. Only few clinical trials suggest that hyperglycemia, glycation, glycoxidation of proteins, lipoproteins, changes in their composition, microalbuminuria, coagulation, fibrinolytic disturbances are additional risk factors of endothelium dysfunction and atherosclerosis. Prevention and treatment of accelerated coronary artery disease and it's consequences are more complicated in the diabetic population than in others. Some of the clinical trials suggest that even improved glycemic control does not eliminate the elevated risk of coronary artery disease in type 1 diabetic patients.