Microvascular complications in diabetes: A growing concern for cardiologists. (15th September 2019) - Avogaro, Angelo
Abstract: Randomized, cross-sectional, and prospective studies have demonstrated that microvascular complications in patients with diabetes are not only the cause of blindness, renal failure and non-traumatic amputations, but also powerful predictors of cardiovascular complications. Beside the metabolic theory, the pathophysiology of diabetic microvascular complications is determined by the interaction among several factors, including epigenetic modifications and the reduced release of progenitor cells by the bone marrow, that contribute simultaneously to damage and impaired vascular protection against hyperglycemia. Identifying and preventing microvascular complications has the significant potential to reduce major adverse cardiovascular events. For these reasons, there may no longer be a rational to consider microangiopathy and macroangiopathy as entirely separate entities, but they should most likely be viewed as a continuum of the widespread vascular damage determined by diabetes mellitus. Highlights: Microvascular complications in patients with diabetes are present non only in eyes, kidneys, and nerves, but also in other organs such as the heart. The concerted action of several processes concur to the pathogenesis of microvascular complications in diabetes. The presence of any retinopathy and DME confer an increased cardiovascular risk. Microvascular complications are responsible for coronary plaque instability. The use of glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporters inhibitors should be considered to reduce CV events.