The Gluco-Vascular Injury Axis in Diabetic Cardiovascular Dysfunction: A Narrative Review.

Area of Science:

• Cardiology
• Endocrinology
• Metabolic Syndrome

Background:

• Diabetic cardiovascular dysfunction is a complex process involving metabolic, vascular, and myocardial components.
• Current understanding often separates mechanisms like hyperglycemia, endothelial dysfunction, and heart failure, obscuring the clinical picture.

Purpose of the Study:

• To propose the "gluco-vascular injury axis" as a conceptual framework integrating diabetic cardiomyopathy, atherosclerosis, and endothelial dysfunction.
• To synthesize evidence into a clinically interpretable continuum of metabolic-vascular-myocardial injury in diabetes.

Main Methods:

• This is a narrative review synthesizing mechanistic, experimental, and clinical evidence.
• It does not employ formal systematic review or meta-analytic methods.

Main Results:

• Diabetes-related metabolic stress drives endothelial dysfunction, leading to vascular injury, microvascular impairment, and myocardial remodeling.
• Key contributors include chronic hyperglycemia, insulin resistance, dyslipidemia, oxidative stress, inflammation, AGE-RAGE signaling, and mitochondrial dysfunction.
• Endothelial dysfunction acts as a critical transition point between metabolic stress and cardiovascular injury.

Conclusions:

• Cardiovascular protection in diabetes requires addressing the entire gluco-vascular injury process.
• Integrated strategies targeting metabolic, endothelial, inflammatory, mitochondrial, microvascular, and myocardial pathways are essential.