title: Pathology of Human Coronary and Carotid Artery Atherosclerosis and Vascular Calcification in Diabetes Mellitus.
abstract: The continuing increase in the prevalence of diabetes mellitus in the general population is predicted to result in a higher incidence of cardiovascular disease. Although the mechanisms of diabetes mellitus-associated progression of atherosclerosis are not fully understood, at clinical and pathological levels, there is an appreciation of increased disease burden and higher levels of arterial calcification in these subjects. Plaques within the coronary arteries of patients with diabetes mellitus generally exhibit larger necrotic cores and significantly greater inflammation consisting mainly of macrophages and T lymphocytes relative to patients without diabetes mellitus. Moreover, there is a higher incidence of healed plaque ruptures and positive remodeling in hearts from subjects with type 1 diabetes mellitus and type 2 diabetes mellitus, suggesting a more active atherogenic process. Lesion calcification in the coronary, carotid, and other arterial beds is also more extensive. Although the role of coronary artery calcification in identifying cardiovascular disease and predicting its outcome is undeniable, our understanding of how key hormonal and physiological alterations associated with diabetes mellitus such as insulin resistance and hyperglycemia influence the process of vascular calcification continues to grow. Important drivers of atherosclerotic calcification in diabetes mellitus include oxidative stress, endothelial dysfunction, alterations in mineral metabolism, increased inflammatory cytokine production, and release of osteoprogenitor cells from the marrow into the circulation. Our review will focus on the pathophysiology of type 1 diabetes mellitus- and type 2 diabetes mellitus-associated vascular disease with particular focus on coronary and carotid atherosclerotic calcification.
authors.affiliation: From the CVPath Institute, Inc, Gaithersburg, MD (K.Y., F.D.K., C.L., H.M., M.E.R., A.V.F., R.V.); and University of Maryland, School of Medicine, Baltimore (A.V.F.).
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Yahagi
authors.affiliation: From the CVPath Institute, Inc, Gaithersburg, MD (K.Y., F.D.K., C.L., H.M., M.E.R., A.V.F., R.V.); and University of Maryland, School of Medicine, Baltimore (A.V.F.).
authors.forename: Frank D
authors.initials: FD
authors.lastname: Kolodgie
authors.affiliation: From the CVPath Institute, Inc, Gaithersburg, MD (K.Y., F.D.K., C.L., H.M., M.E.R., A.V.F., R.V.); and University of Maryland, School of Medicine, Baltimore (A.V.F.).
authors.forename: Christoph
authors.initials: C
authors.lastname: Lutter
authors.affiliation: From the CVPath Institute, Inc, Gaithersburg, MD (K.Y., F.D.K., C.L., H.M., M.E.R., A.V.F., R.V.); and University of Maryland, School of Medicine, Baltimore (A.V.F.).
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Mori
authors.affiliation: From the CVPath Institute, Inc, Gaithersburg, MD (K.Y., F.D.K., C.L., H.M., M.E.R., A.V.F., R.V.); and University of Maryland, School of Medicine, Baltimore (A.V.F.).
authors.forename: Maria E
authors.initials: ME
authors.lastname: Romero
authors.affiliation: From the CVPath Institute, Inc, Gaithersburg, MD (K.Y., F.D.K., C.L., H.M., M.E.R., A.V.F., R.V.); and University of Maryland, School of Medicine, Baltimore (A.V.F.).
authors.forename: Aloke V
authors.initials: AV
authors.lastname: Finn
authors.affiliation: From the CVPath Institute, Inc, Gaithersburg, MD (K.Y., F.D.K., C.L., H.M., M.E.R., A.V.F., R.V.); and University of Maryland, School of Medicine, Baltimore (A.V.F.). rvirmani@cvpath.org.
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
mesh_terms: D000818:Animals; D002339:Carotid Arteries / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D002340:Carotid Artery Diseases / Q000378:metabolism / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D003331:Coronary Vessels / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000473:pathology; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality; D003925:Diabetic Angiopathies / Q000378:metabolism / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D018450:Disease Progression; D006801:Humans; D058226:Plaque, Atherosclerotic; D011379:Prognosis; D012307:Risk Factors; D012422:Rupture, Spontaneous; D061205:Vascular Calcification / Q000378:metabolism / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D066253:Vascular Remodeling
keywords: atherosclerosis; carotid arteries; coronary artery disease; death, sudden; diabetes mellitus