Thrombosis and Vascular Inflammation in Diabetes: Mechanisms and Potential Therapeutic Targets
Cardiovascular disease remains the main cause of morbidity and mortality in patients with diabetes. The risk of vascular ischemia is increased in this population and outcome following an event is inferior compared to individuals with normal glucose metabolism. The reasons for the adverse vascular pr...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2018-01-01
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| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | http://journal.frontiersin.org/article/10.3389/fcvm.2018.00001/full |
| _version_ | 1818671966327930880 |
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| author | Nikoletta Pechlivani Ramzi A. Ajjan |
| author_facet | Nikoletta Pechlivani Ramzi A. Ajjan |
| author_sort | Nikoletta Pechlivani |
| collection | DOAJ |
| description | Cardiovascular disease remains the main cause of morbidity and mortality in patients with diabetes. The risk of vascular ischemia is increased in this population and outcome following an event is inferior compared to individuals with normal glucose metabolism. The reasons for the adverse vascular profile in diabetes are related to a combination of more extensive atherosclerotic disease coupled with an enhanced thrombotic environment. Long-term measures to halt the accelerated atherosclerotic process in diabetes have only partially addressed vascular pathology, while long-term antithrombotic management remains largely similar to individuals without diabetes. We address in this review the pathophysiological mechanisms responsible for atherosclerosis with special emphasis on diabetes-related pathways. We also cover the enhanced thrombotic milieu, characterized by increased platelet activation, raised activity of procoagulant proteins together with compromised function of the fibrinolytic system. Potential new therapeutic targets to reduce the risk of atherothrombosis in diabetes are explored, including alternative use of existing therapies. Special emphasis is placed on diabetes-specific therapeutic targets that have the potential to reduce vascular risk while keeping an acceptable clinical side effect profile. It is now generally acknowledged that diabetes is not a single clinical entity but a continuum of various stages of the condition with each having a different vascular risk. Therefore, we propose that future therapies aiming to reduce vascular risk in diabetes require a stratified approach with each group having a “stage-specific” vascular management strategy. This “individualized care” in diabetes may prove to be essential to improve vascular outcome in this high risk population. |
| first_indexed | 2024-12-17T07:32:24Z |
| format | Article |
| id | doaj.art-45d4a024465741d9b532324a61b3fb5b |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-17T07:32:24Z |
| publishDate | 2018-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-45d4a024465741d9b532324a61b3fb5b2022-12-21T21:58:26ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2018-01-01510.3389/fcvm.2018.00001325956Thrombosis and Vascular Inflammation in Diabetes: Mechanisms and Potential Therapeutic TargetsNikoletta Pechlivani0Ramzi A. Ajjan1School of Medicine, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United KingdomSchool of Medicine, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United KingdomCardiovascular disease remains the main cause of morbidity and mortality in patients with diabetes. The risk of vascular ischemia is increased in this population and outcome following an event is inferior compared to individuals with normal glucose metabolism. The reasons for the adverse vascular profile in diabetes are related to a combination of more extensive atherosclerotic disease coupled with an enhanced thrombotic environment. Long-term measures to halt the accelerated atherosclerotic process in diabetes have only partially addressed vascular pathology, while long-term antithrombotic management remains largely similar to individuals without diabetes. We address in this review the pathophysiological mechanisms responsible for atherosclerosis with special emphasis on diabetes-related pathways. We also cover the enhanced thrombotic milieu, characterized by increased platelet activation, raised activity of procoagulant proteins together with compromised function of the fibrinolytic system. Potential new therapeutic targets to reduce the risk of atherothrombosis in diabetes are explored, including alternative use of existing therapies. Special emphasis is placed on diabetes-specific therapeutic targets that have the potential to reduce vascular risk while keeping an acceptable clinical side effect profile. It is now generally acknowledged that diabetes is not a single clinical entity but a continuum of various stages of the condition with each having a different vascular risk. Therefore, we propose that future therapies aiming to reduce vascular risk in diabetes require a stratified approach with each group having a “stage-specific” vascular management strategy. This “individualized care” in diabetes may prove to be essential to improve vascular outcome in this high risk population.http://journal.frontiersin.org/article/10.3389/fcvm.2018.00001/fullatherosclerosisdiabetes mellitusthrombosisendothelial dysfunctionvascular inflammation |
| spellingShingle | Nikoletta Pechlivani Ramzi A. Ajjan Thrombosis and Vascular Inflammation in Diabetes: Mechanisms and Potential Therapeutic Targets Frontiers in Cardiovascular Medicine atherosclerosis diabetes mellitus thrombosis endothelial dysfunction vascular inflammation |
| title | Thrombosis and Vascular Inflammation in Diabetes: Mechanisms and Potential Therapeutic Targets |
| title_full | Thrombosis and Vascular Inflammation in Diabetes: Mechanisms and Potential Therapeutic Targets |
| title_fullStr | Thrombosis and Vascular Inflammation in Diabetes: Mechanisms and Potential Therapeutic Targets |
| title_full_unstemmed | Thrombosis and Vascular Inflammation in Diabetes: Mechanisms and Potential Therapeutic Targets |
| title_short | Thrombosis and Vascular Inflammation in Diabetes: Mechanisms and Potential Therapeutic Targets |
| title_sort | thrombosis and vascular inflammation in diabetes mechanisms and potential therapeutic targets |
| topic | atherosclerosis diabetes mellitus thrombosis endothelial dysfunction vascular inflammation |
| url | http://journal.frontiersin.org/article/10.3389/fcvm.2018.00001/full |
| work_keys_str_mv | AT nikolettapechlivani thrombosisandvascularinflammationindiabetesmechanismsandpotentialtherapeutictargets AT ramziaajjan thrombosisandvascularinflammationindiabetesmechanismsandpotentialtherapeutictargets |