Both smoking-related and diabetes-related peripheral artery disease exhibit increased thrombo-inflammatory responses, though the specific magnitude of thrombo-inflammation in diabetes compared with smokers remains unknown.
This review emphasizes the pathophysiological differences between diabetes- and smoking-related PAD, advocating for disease-specific therapeutic strategies rather than a one-size-fits-all approach.
Peripheral artery disease (PAD) is a major health problem with increased cardiovascular mortality, morbidity and disabling critical limb threatening ischemia (CLTI) and amputation. Diabetes mellitus (DM) and cigarette smoke are the main risk factors for the development of PAD. Although diabetes related PAD shows an accelerated course with worse outcome regarding complications, mortality and amputations compared with non-diabetic patients, current medical treatment does not make this distinction and includes standard antiplatelet and lipid lowering drugs for all patients with PAD. In this review we discuss the pathophysiologic mechanisms of PAD, with focus on differences in thrombo-inflammatory processes between diabetes-related and smoking-related PAD, and hypothesize on possible mechanisms for the progressive course of PAD in DM. Furthermore, we comment on current medical treatment and speculate on alternative medical drug options for patients with PAD and DM.
Alnima et al. (2023) conducted a review in Peripheral artery disease. Both smoking-related and diabetes-related peripheral artery disease exhibit increased thrombo-inflammatory responses, though the specific magnitude of thrombo-inflammation in diabetes compared with smokers remains unknown.