Abstract
Diabetes mellitus (DM) is a strong risk factor for the development of cardiovascular diseases such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease (PAD). In the population of people living with DM, PAD is characterised by multi-level atherosclerotic lesions as well as greater involvement of the arteries below the knee. DM is also a factor that significantly increases the risk of lower limb amputation. Percutaneous balloon angioplasty with or without stent implantation is an important method of the treatment for atherosclerotic cardiovascular diseases, but restenosis is a factor limiting its long-term effectiveness. The pathogenesis of atherosclerosis in the course of DM differs slightly from that in the general population. In the population of people living with DM, more attention is drawn to such factors as inflammation, endothelial dysfunction, platelet dysfunction, blood rheological properties, hypercoagulability, and additional factors stimulating vascular smooth muscle cell proliferation. DM is a risk factor for restenosis. The purpose of this paper is to provide a review of the literature and to present the most important information on the current state of knowledge on mechanisms and the clinical significance of restenosis and in-stent restenosis in patients with DM, especially in association with the endovascular treatment of PAD. The role of such processes as inflammation, neointimal hyperplasia and neoatherosclerosis, allergy, resistance to antimitotic drugs used for coating stents and balloons, genetic factors, and technical and mechanical factors are discussed. The information on restenosis collected in this publication may be helpful in planning further research in this field, which may contribute to the formulation of more and more precise recommendations for the clinical practice.
Highlights
The purpose of this paper is to provide a review of the literature and to present the most important information on the current state of knowledge of mechanisms and the clinical significance of restenosis and in-stent restenosis (ISR) in patients with diabetes, especially in association with the endovascular treatment of peripheral arterial disease (PAD)
Studies on vascular smooth muscle cells (VSMCs) isolated from the aorta of wild-type (WT) and Tnfrsf12a knockout mice showed that tumour necrosis factor-like weak inducer of apoptosis (TWEAK) via the Fn14 receptor stimulates the proliferation of VSMCs
The information collected in this study may be helpful in planning further research on restenosis, which may contribute to the development of more and more precise recommendations for clinical practice
Summary
Diabetes mellitus (DM) and its complications constitute one of the most important problems in public health worldwide. 382 million people were estimated to have DM in 2013 and this number is expected to increase to 592 million by 2035 [1]. Diabetes mellitus (DM) and its complications constitute one of the most important problems in public health worldwide. Approximately 462 million individuals were affected by type 2 DM in 2017 [2]. Type 1 DM (T1DM) is responsible for approximately 5–10% of cases, and autoimmune damage to beta cells is responsible for its development, leading to insulin deficiency. Res. Public Health 2021, 18, 11970 in patients with DM [5], and on the other hand, DM worsens the prognosis in patients with. CVD [4], so improving the knowledge about pathogenesis and the development of more effective methods for diagnosis and treatment of cardiovascular diseases play a crucial role
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