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Review
. 2023 Sep 21;22(1):257.
doi: 10.1186/s12933-023-01990-6.

Diabetes- versus smoking-related thrombo-inflammation in peripheral artery disease

T Alnima  1   2 , R I Meijer  3 , H M H Spronk  4 , M Warlé  5 , H Ten Cate  4
Affiliations
Review

Diabetes- versus smoking-related thrombo-inflammation in peripheral artery disease

T Alnima et al. Cardiovasc Diabetol. .

Abstract

Peripheral artery disease (PAD) is a major health problem with increased cardiovascular mortality, morbidity and disabling critical limb threatening ischemia (CLTI) and amputation. Diabetes mellitus (DM) and cigarette smoke are the main risk factors for the development of PAD. Although diabetes related PAD shows an accelerated course with worse outcome regarding complications, mortality and amputations compared with non-diabetic patients, current medical treatment does not make this distinction and includes standard antiplatelet and lipid lowering drugs for all patients with PAD. In this review we discuss the pathophysiologic mechanisms of PAD, with focus on differences in thrombo-inflammatory processes between diabetes-related and smoking-related PAD, and hypothesize on possible mechanisms for the progressive course of PAD in DM. Furthermore, we comment on current medical treatment and speculate on alternative medical drug options for patients with PAD and DM.

Keywords: Diabetes mellitus; Inflammation; Peripheral artery disease; Smoking; Thrombosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Pathological pathways leading to angiopathy and peripheral artery disease in diabetes mellitus and cigarette smoking. DM: diabetes mellitus
Fig. 2
Fig. 2
Hypothetical image of the increasingly thrombo-inflammatory processes behind the course of peripheral artery disease in diabetes mellitus compared with cigarette smoking. DM: diabetes mellitus. NO: nitric oxide. ROS: reactive oxygen species. TF: tissue factor. TNF-α: tumor necrosis factor-α. PAI-1: plasminogen activator inhibitor-1. TAFI: thrombin activatable fibrinolysis inhibitor
See this image and copyright information in PMC

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