Cardiovascular disease in diabetes: An enigma of dyslipidemia, thrombosis and inflammation

The purpose of this review is to explain cardiovascular problems and different risk factors that lead to cardiovascular disease (CVD). Moreover, the possible mechanisms that lead to accelerated atherogenesis in DM are also discussed. According to ATP III guidelines Diabetes Mellitus is considered to be a coronary heart disease (CHD) equivalent. From cardiovascular medicine aspect, it may be appropriate to say that "diabetes is a cardiovascular disease." Diabetics have a very high prevalence of cardiovascular disease morbidity and mortality. The conditions of insulin resistance, impaired glucose tolerance (IGT) and overt diabetes, appear to be associated with an increased risk of CVD to a variable degree. One question which still remains unresolved is whether hyperglycemia or insulin resistance leads to CVD in DM. It seems that both DM and CVD originate from a common soil. Still the pathophysiology of CVD is poorly understood and many new concepts have emerged the new enigma of dyslipidemia, thrombosis and inflammation has emerged. Since this concept has emerged, many new markers of cardiovascular risk prediction have come up and prove to be important clinically because infarction often occurs among diabetics without traditional risk factors. This has lead to intense research in novel cardiovascular risk markers which will help in assessment and identification of persons who are prone to premature atherothrombosis. Still the relative contribution of each of these markers to CVD risk is beyond understanding. In coming future we may have excellent risk markers in our routine clinical practice which would allow a better prediction of patients at high risk for designing more effective strategies for primary and secondary prevention. The research areas that need to be focused on are metabolic stress, oxidative stress, endothelial dysfunction, inflammation and thrombosis/fibrinolysis. Studies are needed in each of these areas relevant to basic and clinical sciences to elucidate the complex interaction of hyperglycemia, dyslipidemia and inflammation at all stages of CVD.