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Large and micro coronary vascular involvement in diabetes
1Scuola Superiore S. Anna and CNR Institute of Clinical Physiology, via G. Moruzzi 1, 56124 Pisa, Italy. segrlabb@ifc.cnr.it
Insights
Diabetes significantly impacts heart health, often causing reduced coronary flow reserve due to microcirculatory dysfunction, even without obstructive coronary disease. Further research is needed to understand its clinical relevance in diabetic patients.
Area of Science:
- Cardiology
- Diabetology
- Medical Research
Background:
- Diabetes mellitus, characterized by hyperglycemia, is a significant risk factor for ischemic heart disease.
- The precise role of coronary artery disease in the poor prognosis of diabetes remains debated, despite recognized higher prevalence and extent of coronary atherosclerosis.
- Coronary microcirculation dysfunction is increasingly implicated in diabetic cardiovascular complications.
Purpose of the Study:
- To review existing evidence on coronary involvement in diabetes, focusing on microcirculatory aspects.
- To highlight findings of reduced coronary flow reserve in type 2 diabetes, often independent of obstructive coronary artery disease.
- To discuss the implications of microcirculatory dysfunction on left ventricular function and its potential prognostic value.
Main Methods:
- Review of available scientific literature and studies on coronary involvement in diabetes.
- Analysis of data from studies utilizing various techniques to assess coronary flow reserve and myocardial perfusion.
- Examination of findings from single-photon myocardial scintigraphy in asymptomatic diabetic individuals.
Main Results:
- Several studies indicate reduced coronary flow reserve in diabetic patients, particularly type 2 diabetes, even without significant obstructive coronary disease.
- Microcirculatory dysfunction in diabetes can affect the left ventricle both globally and regionally.
- Prevalence estimates suggest that regional perfusion disturbances without obstructive coronary disease may range from 11% to 63% in diabetic populations.
Conclusions:
- Coronary microcirculatory dysfunction is a notable finding in diabetes, impacting myocardial perfusion.
- The prevalence, natural course, and prognostic significance of this microcirculatory abnormality require further dedicated investigation.
- More extensive research is essential to elucidate the pathogenesis and clinical relevance of coronary microcirculatory dysfunction in the context of diabetes.
Abstract:
Diabetes, with hyperglycemia as its hallmark, is a major risk factor for ischemic heart disease. The role of coronary disease in the adverse prognosis of diabetes is controversial although the higher prevalence and extension of coronary atherosclerosis is well recognized. The paper reviews the available evidence of coronary involvement in diabetes with particular emphases on microcirculation. Several studies, mainly in type 2 diabetes, have documented a reduced coronary flow reserve even in absence of coronary obstructive disease and using different techniques. Microcirculatory dysfunction affects the left ventricle globally as well as regionally. However, neither the prevalence of such abnormality in the diabetic population nor its time course and its prognostic value have been investigated in specifically addressed studies. In fact, a relatively large number of studies on myocardial perfusion performed by single-photon myocardial scintigraphy in asymptomatic diabetics rather address the problem of the prevalence of silent ischemia and its prognostic value. In spite of such limitation it can be speculated from the few available studies with known coronary anatomy that the prevalence of exclusively regional disturbances of perfusion (scintigraphic defects) in absence of obstructive coronary disease is not marginal as it ranges from 11 to 63%. Extensive research is still required to define the pathogenesis and the actual clinical relevance of coronary microcirculatory dysfunction in diabetes.
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