The Vasculature in Prediabetes

Circ Res. 2018 Apr 13;122(8):1135-1150. doi: 10.1161/CIRCRESAHA.118.311912.

Abstract

The frequency of prediabetes is increasing as the prevalence of obesity rises worldwide. In prediabetes, hyperglycemia, insulin resistance, and inflammation and metabolic derangements associated with concomitant obesity cause endothelial vasodilator and fibrinolytic dysfunction, leading to increased risk of cardiovascular and renal disease. Importantly, the microvasculature affects insulin sensitivity by affecting the delivery of insulin and glucose to skeletal muscle; thus, endothelial dysfunction and extracellular matrix remodeling promote the progression from prediabetes to diabetes mellitus. Weight loss is the mainstay of treatment in prediabetes, but therapies that improved endothelial function and vasodilation may not only prevent cardiovascular disease but also slow progression to diabetes mellitus.

Keywords: cardiovascular disease; extracellular matrix; insulin resistance; metabolic syndrome; obesity.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Animals
  • Blood Vessels / physiopathology*
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / physiopathology
  • Combined Modality Therapy
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diet, Reducing
  • Disease Progression
  • Endothelium, Vascular / physiopathology
  • Extracellular Matrix / metabolism
  • Fatty Acids, Nonesterified / metabolism
  • Fibrinolysis
  • Glucose / metabolism
  • Humans
  • Hyperglycemia / etiology
  • Hyperglycemia / physiopathology
  • Hypoglycemic Agents / therapeutic use
  • Inflammation / physiopathology
  • Insulin Resistance
  • Life Style
  • Metabolic Syndrome / physiopathology
  • Mice
  • MicroRNAs / genetics
  • Microcirculation*
  • Muscle, Skeletal / metabolism
  • Obesity / physiopathology
  • Prediabetic State / epidemiology
  • Prediabetic State / pathology
  • Prediabetic State / physiopathology*
  • Prediabetic State / therapy
  • Risk
  • Weight Loss

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Fatty Acids, Nonesterified
  • Hypoglycemic Agents
  • MicroRNAs
  • Glucose