The interplay between diabetes and atherosclerosis: A review of pathophysiological mechanisms

Atherosclerosis, characterized by lipid accumulation in arterial walls, is a leading cause of cardiovascular morbidity and mortality, with increased prevalence among individuals with diabetes mellitus. Diabetes is a chronic condition marked by persistently high blood glucose levels, a condition that can potentially result in long-term complications, including heart, blood vessel, eye, kidney, and nerve damage. Diabetes, marked by chronic hyperglycemia, contributes to atherogenesis through mechanisms including endothelial dysfunction, oxidative stress, formation of advanced glycation end-products (AGEs), and chronic inflammation. This study provides a synopsis of the predominant characteristics of diabetes that may potentially impact the atherogenic process, including oxidative stress, altered protein kinase signaling, and the role of select microRNAs and epigenetic modifications. This review comprehensively examines literature from 1969 to 2025, focusing on the molecular and cellular pathways linking diabetes to atherosclerosis. Effective glycemic control and management of associated risk factors remain pivotal in mitigating atherosclerotic progression in diabetic patients. Understanding these interconnected mechanisms is essential for developing targeted therapies to reduce cardiovascular complications associated with diabetes.