Coronary Microvascular Dysfunction in Diabetes Mellitus: Pathogenetic Mechanisms and Potential Therapeutic Options.
Teresa SalvatoreRaffaele GalieroAlfredo CaturanoErica VetranoGiuseppe LoffredoLuca RinaldiChristian CataliniKlodian GjeloshiGaetana AlbaneseAnna Di MartinoGiovanni DocimoCelestino SarduRaffaele MarfellaFerdinando Carlo SassoPublished in: Biomedicines (2022)
Diabetic patients are frequently affected by coronary microvascular dysfunction (CMD), a condition consisting of a combination of altered vasomotion and long-term structural change to coronary arterioles leading to impaired regulation of blood flow in response to changing cardiomyocyte oxygen requirements. The pathogenesis of this microvascular complication is complex and not completely known, involving several alterations among which hyperglycemia and insulin resistance play particularly central roles leading to oxidative stress, inflammatory activation and altered barrier function of endothelium. CMD significantly contributes to cardiac events such as angina or infarction without obstructive coronary artery disease, as well as heart failure, especially the phenotype associated with preserved ejection fraction, which greatly impact cardiovascular (CV) prognosis. To date, no treatments specifically target this vascular damage, but recent experimental studies and some clinical investigations have produced data in favor of potential beneficial effects on coronary micro vessels caused by two classes of glucose-lowering drugs: glucagon-like peptide 1 (GLP-1)-based therapy and inhibitors of sodium-glucose cotransporter-2 (SGLT2). The purpose of this review is to describe pathophysiological mechanisms, clinical manifestations of CMD with particular reference to diabetes, and to summarize the protective effects of antidiabetic drugs on the myocardial microvascular compartment.
Keyphrases
- coronary artery disease
- oxidative stress
- aortic stenosis
- coronary artery
- ejection fraction
- blood flow
- left ventricular
- heart failure
- percutaneous coronary intervention
- cardiovascular events
- coronary artery bypass grafting
- insulin resistance
- type diabetes
- glycemic control
- diabetic rats
- transcatheter aortic valve replacement
- cardiovascular disease
- adipose tissue
- dna damage
- electronic health record
- metabolic syndrome
- aortic valve
- stem cells
- acute coronary syndrome
- big data
- endothelial cells
- atrial fibrillation
- mesenchymal stem cells
- blood glucose
- skeletal muscle
- blood pressure
- polycystic ovary syndrome
- acute heart failure
- signaling pathway
- machine learning