Hormonal
Microvascular dysfunction, including rarefaction and endothelial dysfunction, contributes to cardiovascular risk in diabetes independently of macrovascular atherosclerosis, explaining symptoms like microvascular angina even with normal coronary arteries.
In diabetes, damage to the tiny blood vessels (microcirculation) can cause heart symptoms like angina and heart failure, even if the main coronary arteries are clear. This is due to reduced vessel density (rarefaction) and poor blood vessel function. Recognizing microvascular dysfunction is key to managing heart health in diabetes, as standard tests for blockages may miss this issue.
Although not associated with atherosclerosis, this predicts cardiac symptoms, and may explain the high prevalence of refractory [47] and microvascular angina [31], especially in people with diabetes, despite normal or only mildly diseased coronary arteries.
Why this rating
Supported by multiple studies cited in the review regarding microvascular angina and coronary flow reserve.
Source
Diabetes, cardiovascular disease and the microcirculation
W. David Strain et al. · Cardiovascular Diabetology · 2018
DOI 10.1186/s12933-018-0703-2
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