Ghafoury Roya, Malek Mojtaba, Ismail-Beigi Faramarz, Khamseh Mohammad E
Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), No. 10, Firoozeh St, Vali-asr Ave, Vali-asr Sq, Tehran, 1593716615, Iran.
Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), No. 10, Firoozeh St, Vali-asr Ave, Vali-asr Sq, Tehran, 1593716615, Iran.
Diabetes Ther. 2025 May 9. doi: 10.1007/s13300-025-01743-6.
Type 2 diabetes mellitus (T2DM) is a global health crisis, with cardiovascular disease (CVD) accounting for 75% of mortality in this population. Despite advances in managing traditional risk factors, such as low-density lipoprotein cholesterol (LDL) cholesterol reduction (IMPROVE-IT, FOURIER), antithrombotic therapies (PEGASUS, COMPASS), and triglyceride-lowering agents (REDUCE-IT), a substantial residual cardiovascular risk persists, driven in part by chronic low-grade systemic inflammation. Chronic low-grade inflammation is a central driver of cardiovascular-kidney-metabolic (CKM) syndrome in T2DM, perpetuating residual cardiovascular risk despite optimal management of traditional risk factors. This narrative review synthesizes evidence on how inflammation accelerates coronary heart disease (CHD), heart failure (HF), stroke, diabetic kidney disease (DKD), and peripheral artery disease (PAD). We evaluate the anti-inflammatory mechanisms of current therapies such as statins, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and glucagon-like peptide 1 (GLP-1) receptor agonists, as well as emerging agents like colchicine and interleukin (IL)-1β/IL-6 inhibitors, emphasizing their differential efficacy across CKM traits. By integrating pathophysiological insights with clinical trial data, we propose biomarker-guided strategies to target inflammation as a modifiable risk factor, offering a roadmap to bridge the gap in diabetes-related cardiovascular care.
2型糖尿病（T2DM）是一场全球性的健康危机，心血管疾病（CVD）导致该人群75%的死亡。尽管在管理传统风险因素方面取得了进展，如降低低密度脂蛋白胆固醇（LDL）（IMPROVE-IT、FOURIER研究）、抗血栓治疗（PEGASUS、COMPASS研究）以及降甘油三酯药物（REDUCE-IT研究），但仍存在大量残余心血管风险，部分原因是慢性低度全身炎症。慢性低度炎症是T2DM中心血管-肾脏-代谢（CKM）综合征的主要驱动因素，尽管对传统风险因素进行了优化管理，但仍使残余心血管风险持续存在。这篇叙述性综述综合了关于炎症如何加速冠心病（CHD）、心力衰竭（HF）、中风、糖尿病肾病（DKD）和外周动脉疾病（PAD）的证据。我们评估了当前疗法的抗炎机制，如他汀类药物、钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂和胰高血糖素样肽1（GLP-1）受体激动剂，以及秋水仙碱和白细胞介素（IL）-1β/IL-6抑制剂等新兴药物，强调它们在CKM特征方面的不同疗效。通过将病理生理学见解与临床试验数据相结合，我们提出了以生物标志物为导向的策略，将炎症作为一个可改变的风险因素进行靶向治疗，为弥合糖尿病相关心血管护理方面的差距提供了路线图。
