Diabetes and ageing‐induced vascular inflammation

Abstract

Diabetes and the ageing process independently increase the risk for cardiovascular disease (CVD). Since incidence of diabetes increases as people get older, the diabetic older adults represent the largest population of diabetic subjects. This group of patients would potentially be threatened by the development of CVD related to both ageing and diabetes. The relationship between CVD, ageing and diabetes is explained by the negative impact of these conditions on vascular function. Functional and clinical evidence supports the role of vascular inflammation induced by the ageing process and by diabetes in vascular impairment and CVD. Inflammatory mechanisms in both aged and diabetic vasculature include pro‐inflammatory cytokines, vascular hyperactivation of nuclear factor‐кB, increased expression of cyclooxygenase and inducible nitric oxide synthase, imbalanced expression of pro/anti‐inflammatory microRNAs, and dysfunctional stress‐response systems (sirtuins, Nrf2). In contrast, there are scarce data regarding the interaction of these mechanisms when ageing and diabetes co‐exist and its impact on vascular function. Older diabetic animals and humans display higher vascular impairment and CVD risk than those either aged or diabetic, suggesting that chronic low‐grade inflammation in ageing creates a vascular environment favouring the mechanisms of vascular damage driven by diabetes. Further research is needed to determine the specific inflammatory mechanisms responsible for exacerbated vascular impairment in older diabetic subjects in order to design effective therapeutic interventions to minimize the impact of vascular inflammation. This would help to prevent or delay CVD and the specific clinical manifestations (cognitive decline, frailty and disability) promoted by diabetes‐induced vascular impairment in the elderly.

Frailty and sarcopenia as the basis for the phenotypic manifestation of chronic diseases in older adults

“…Although the mechanism(s) leading to this event have not been completely elucidated, inflammation has been proposed as a key factor in the exaggerated vascular damage produced when aging and diabetes coexist (El Assar et al, 2015). In any case, cardiovascular complications linked to the presence of diabetes in the older persons would likely contribute to the facilitatory role of diabetes in the development of frailty in the elderly.…”

The emergence of frailty and sarcopaenia in diabetes mellitus: description of inter-relationships and clinical importance

“…Goldberg et al [70] Assar et al [71] Obesity Obesity is a causative factor in the development of both type 2 diabetes and frailty; it impairs physical activity and thereby promotes further muscle mass loss. This potentially leads to 'sarcopaenic obesity', a major risk factor for the onset of physical disability [72].…”

“…However, data are lacking on the interaction of mechanisms when diabetes and ageing coexist, a state that seems to exacerbate vascular damage compared with diabetes or ageing alone. This suggests that chronic inflammatory changes associated with ageing may promote an environment favouring the mechanisms of diabetic vasculopathy [71]. Further research is needed to underline the specific mechanisms involved to consider a targeted intervention.…”

Oxidative Stress and Antioxidant Status in Immune Thrombocytopenia

“…Endothelial inflammation, mitochondrial oxidative stress would be activated in the condition of high glucose levels. Therefore, type 2 diabetes (T2D) would be served as a prime example of an interplay between metabolism and immunity, making it prototypic for an in depth look into immunometabolism [14][15][16]. Growing evidence implies that immune cells possess an essential effect on the development of insulin resistance and then complications of T2D [17][18][19].…”