Shifting arterial disease patterns in diabetes

Research at the University of Gothenburg finds changes in arterial disease risks for type 1 and 2 diabetes. Heart attack and stroke risks decrease, while complications in peripheral vessels become more critical.

Diabetes raises the risk of heart attack and stroke due to factors like obesity, high blood pressure, and lipid disorders. However, the impact of diabetes and these risk factors on blood vessels outside central organs, like the heart and brain, hasn’t been extensively studied.

Two publications published in The Lancet Regional Health—Europe address this gap. To better understand peripheral artery disorders, researchers examined illness trends over a 20-year period.

Researchers analyzed two decades of disease trends to better understand peripheral arterial diseases. They examined long-term trends, control of modifiable risk factors, optimal levels for cardiometabolic risks, and the relative importance of selected risk factors.

The studies examined data from the Swedish National Diabetes Register from 2001 to 2020, including 34,263 individuals with type 1 diabetes, 655,250 with type 2 diabetes, and 2,676,227 individuals without diabetes for comparison.

They examined several problems with blood vessels outside of the heart and brain, including small vessel disease in the foot, problems with the abdominal aorta, and peripheral blood vessels in the legs, including calcification and hernias in the carotid artery.

Most of these complications decreased over time for both types of diabetes. However, the risk has shifted gradually from arterial diseases in the heart and brain towards complications in peripheral vessels.

The findings imply that in individuals with type 1 diabetes, regular long-term blood pressure and blood sugar monitoring can reduce the incidence of various peripheral vascular problems by 30–50%. These comprise small vessel disease in the foot, peripheral leg vessels, abdominal aorta, and carotid artery calcification.

However, lowering current guideline values for BMI, cholesterol, and triglycerides or improving renal function may not benefit type 1 diabetes patients much. In type 2 diabetes, high levels of “bad” cholesterol are linked to carotid artery calcification. In contrast, lower triglyceride levels reduce the risk of peripheral arterial disease. Yet, being above the current triglyceride guideline value doesn’t increase risk.

In both type 1 and type 2 diabetes, long-term high blood sugar levels are the most significant indicator for peripheral arterial disease, unlike central artery issues. Long-term elevated blood sugar also reduces the incidence of arterial ruptures and hernias while strengthening the aorta.

These results highlight the unique effects of chronic blood sugar on every bodily vessel and the distinctions between peripheral and central arteries. Aidin Rawshani, a University of Gothenburg researcher, directed these research projects.

Aidin Rawshani said, “Our results reveal the potential for an even greater risk reduction for future events by maintaining lower levels of cardiometabolic risk factors, particularly early and intensive control of long-term blood sugar. We also noted that the relative importance of these risk factors differs between the central and peripheral arteries, revealing differences in biological effects that cardiometabolic risk factors exert in different parts of the arterial tree. Long-term blood sugar plays a much more significant role in developing peripheral arterial disease.”

These findings highlight a significant change in the types of arterial diseases in diabetes, with a decrease in central artery complications and a rise in peripheral vessel issues. Also, how high blood sugar affects different arteries shows that we need specific plans to manage diabetes better.

Journal reference:

1. Araz Rawshani, Björn Eliasson, et al., Non-coronary peripheral arterial complications in people with type 2 diabetes: a Swedish retrospective cohort study. The Lancet Regional Health. DOI: 10.1016/j.lanepe.2024.100888.
2. Tarik Avdic, Björn Eliasson, et al., Non-coronary arterial outcomes in people with type 1 diabetes mellitus: a Swedish retrospective cohort study. The Lancet Regional Health. DOI: 10.1016/j.lanepe.2024.100852.