Clinical Implications of Serum Biomarkers in Diabetic Cardiovascular Complications

Abstract

Diabetes is associated with increased risk of cardiovascular disease, with atherosclerosis responsible for most associated morbidity and mortality. Atherosclerosis often causes acute thrombotic events through plaque rupture and formation of platelet-rich thrombi. The principal clinical manifestations of atherosclerosis are coronary artery disease, ischemic stroke, and peripheral arterial disease. Endothelial dysfunction, oxidative stress, and low-grade inflammation are key features in the pathophysiology of atherosclerosis. Diabetes is also associated with hypercoaguable states and endothelial injury. Hyperactivated platelets at injured endothelial surfaces act together due to the increased availability of thrombotic precursors and diminished fibrinolysis. Advances in the understanding of the pathogenesis of atherosclerosis associated with diabetes have yielded new hypotheses regarding the links between risk factors and the cellular and molecular alterations that underlie cardiovascular disease. Rec ently, there has been increasing interest in utilizing novel biomarkers of cardiovascular disease risk that have the potential to be useful indicators for better risk assessment, diagnosis, and prognosis. However, to d ate, most conventional and emerging biomarkers have only modest predictive values, and there remains a need to identify additional biomarkers using new biological approaches. This review highlights the clinical implications of emerging biomarkers associated with cardiovascular disease in patients with diabetes and recent developments in new technologies for the identification of biomarkers. (Korean Diabetes J 33:363-372, 2009)