Is ischemia the only factor predicting cardiovascular outcomes in all diabetes mellitus patients?

Area of Science:

• Cardiology
• Diabetology
• Vascular Biology

Background:

• Diabetes mellitus (DM) significantly increases cardiovascular morbidity and mortality, with higher rates of coronary artery disease.
• Atherosclerosis in DM patients progresses faster and is more complex than in non-DM individuals.
• Ischemia is a primary predictor of cardiac events, guiding revascularization strategies.

Purpose of the Study:

• To review evidence for ischemia-driven revascularization in DM patients.
• To challenge the sole reliance on ischemia for cardiovascular risk prediction in DM.
• To explore if factors beyond ischemia, like microvascular disease and plaque characteristics, are vital for risk stratification.

Main Methods:

• Literature review of current evidence on revascularization strategies in DM.
• Analysis of studies investigating cardiovascular outcomes in DM patients with and without ischemia.
• Examination of factors beyond ischemia, including atherosclerosis burden, progression, and plaque composition.

Main Results:

• Recent data suggest DM patients with coronary atherosclerosis may have elevated cardiac event risk, even without detectable ischemia.
• The predictive value of ischemia alone for cardiac events in DM patients is questioned.
• Non-ischemic factors may influence cardiovascular outcomes in DM.

Conclusions:

• Ischemia may not be the only critical factor for predicting cardiovascular outcomes in all DM patients.
• Microvascular disease, atherosclerosis burden, progression, and plaque composition warrant consideration for refined risk stratification.
• A comprehensive approach beyond ischemia is needed for managing cardiovascular risk in DM.