Exploring the Correlation and Protective Role of Diabetes Mellitus in Aortic Aneurysm Disease

Abstract

Introduction: Diabetes mellitus is recognised as a significant risk factor for cardiovascular and peripheral vascular disease, as the abnormal metabolic state increases the risk for atherosclerosis, occlusive arterial disease and vascular dysfunction. There have been reports of potential association across the literature that illustrates a link between diabetes mellitus and aortic aneurysm, with the former having a protective role on the development of the latter.Methods: A thorough literature search was performed through electronic databases, to provide a comprehensive review of the study's reporting on the association of diabetes mellitus and aortic aneurysm, discussing the mechanisms that have been reported; furthemore, we reviewed the reports of the impact of oral hypoglycameic agents on aortic aneurysms.Results: Various proposed mechanisms are involved in this protective process including endothelial dysfunction, chronic hyperglycemia and insulin resistance. The evidence suggests a negative association between these disease process, with prevelance of diabetes mellitus resulting in lower rates of aortic aneurysm, via its protective mechanistic action. The increase in advanced glycation end products, increased arterial stiffness and vascular remodelling seen in diabetes, was found to have a profound impact on aneurysm development, its slow progression and lower rupture rate in these individuals. This review has also highlighted the role of oral hypoglycaemic agents having a protective effect against AA disease.Conclusion: A decrease in development, progression and mortality from aortic aneurysms as well as reduced rates of dissection, have been observed in those with diabetes. This review has provided a comprehensive insight on the effect of diabetes and its physiological processes, and elements of its con-committant treatment, having a protective role against these aortic diseases.

Prevalence, Predictors, and Impact of Coronary Artery Ectasia in Patients With Atherosclerotic Heart Disease

“…24 In spite of limited evidence of the inverse relationship between diabetes and CAE, multiple epidemiological studies have confirmed a lower prevalence of aortic aneurysm in patients with diabetes mellitus. 25 The mechanisms by which diabetes mellitus has protective effects in the development and progression of aortic aneurysm still represent an important research question. 26 Additionally, CAE tended to be more frequent in younger patients, 27 indicating that CAE might not simply represent a variant of atherosclerosis.…”

Ophthalmic artery changes in type 2 diabetes with and without acute coronary syndrome

“…Therefore, it is hypothesized that the increase in ET-1 level is possibly one of the main reasons for the decrease in OA diameter in patients with diabetes. Regarding macrovascularity, studies in recent years have reported its protective effect on aortic aneurysm disease [ 26 , 27 ], which is associated with the decrease in matrix metalloproteinase activity by high glucose level [ 28 ], the non-enzymatic cross-linking of advanced glycation end products between the basement membrane of the extracellular matrix, and the stimulation of the tumor growth factor-β signaling pathway to maintain vascular smooth muscle cell homeostasis [ 27 ]. However, studies have found that a smaller retinal artery diameter is associated with the incidence of ACS, especially in women [ 29 ], which is inconsistent with the larger OA diameter in our study.…”

Double-edged sword of diabetes mellitus for abdominal aortic aneurysm

“…MMPs are calcium-dependent zinc endopeptidases secreted by vascular endothelial cells and macrophages; they play a key role in the pathogenesis of AAA. Both MMP-2 (released by smooth muscle) and MMP-9 (released by macrophages) were found involved in the process of matrix destruction and vessel wall degradation in aortic aneurysms (9). Expression of MMP-9 was observed elevated at the site of AAA rupture, and was additionally associated with ruptured aneurysm related 30-day mortality (17,18).…”

“…The mechanism underlying the pathogenesis of AAA was found related to the biology of abdominal aortic wall. Diabetic patients were shown to have decreased levels of matrix metalloproteinases (MMPs) and matrix degradation, enhanced matrix and collagen synthesis, resulting in a thicker abdominal aortic wall and a larger volume of extracellular matrix (ECM) (7,9,10).…”

“…Diabetes mellitus induces glycation of the ECM, which subsequently stimulates the formation of advanced glycation end products (AGE) (7). AGEs are covalently cross-linked with elastin and collagen in the blood vessel wall, promoting protection against mechanical structure loss and contributing to arterial stiffness (7,9,11,12). Although enhanced arterial stiffness is a risk factor for atherosclerotic diseases, it provides resistance towards aneurysm growth delays AAA progression (12,13).…”