EVMS School of Health Professions Faculty Publications

ORCID

0000-0002-8163-0527 (Carbone)

Document Type

Article

Publication Date

2026

DOI

10.20517/mtod.2026.84

Publication Title

Metabolism and Target Organ Damage

Volume

6

Issue

2

Pages

31

Abstract

[Introduction] Diabetic cardiovascular disease is a network disorder, not a glucose-only complication

Diabetes accelerates cardiovascular (CV) target-organ damage through multiple interacting biological modules that amplify risk even when glycemia is modestly controlled[1]. These modules include (i) adipose tissue dysfunction with altered adipokine secretion and immune-cell infiltration; (ii) ectopic lipid deposition in liver, myocardium, and perivascular/epicardial fat (iii) endothelial dysfunction with impaired nitric oxide bioavailability and heightened oxidative stress (iv) chronic kidney disease (CKD)-mediated volume, pressure, and uremic-toxin stress, and (v) autonomic and neurohormonal activation that promotes hypertension, arrhythmias, and remodeling[1]. The clinical spectrum includes macrovascular disease as well as myocardial, renal, and microvascular complications, including heart failure (HF) with preserved ejection fraction (HFpEF), diabetic cardiomyopathy, CKD, and coronary microcirculatory dysfunction[1]. Importantly, cardiometabolic risk accrues even before overt diabetes; emerging evidence suggests that achieving remission of prediabetes is associated with lower subsequent cardiorenal and CV morbidity[2], reinforcing prevention and early intervention as core therapeutic strategies. Likewise, the distribution of body fat (visceral and ectopic depots) may be more relevant to risk modification than body weight alone[3].

Rights

© The Authors 2026

This article is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License, which permits unrestricted use, sharing, adaptation, distribution, and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original authors and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Data Availability

Article states: "Not applicable."

Original Publication Citation

Sanchis-Gomar, F., Lavie, C. J., Carbone, S., & Neeland, I. J. (2026). Mechanism-driven therapy for diabetic cardiovascular disease. Metabolism and Target Organ Damage, 6(2), Article 31. https://doi.org/10.20517/mtod.2026.84

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