Despite the decades-old knowledge that diabetes mellitus is a major risk factor for cardiovascular disease, the reasons for this association are only partially understood. While this association is true for both type 1 and type 2 diabetes, different pathophysiological processes may be responsible. Lipids and other risk factors are indeed important, whereas the role of glucose is less clear. This lack of clarity stems from clinical trials that do not unambiguously show that intensive glycemic control reduces cardiovascular events. Animal models have provided mechanisms that link diabetes to increased atherosclerosis, and evidence consistent with the importance of factors beyond hyperglycemia has emerged. We review clinical, pathological, and animal studies exploring the pathogenesis of atherosclerosis in humans living with diabetes and in mouse models of diabetes. An increased effort to identify risk factors beyond glucose is now needed to prevent the increased cardiovascular disease risk associated with diabetes.

尽管几十年前就知道糖尿病是心血管疾病的主要危险因素，但这种关联的原因只是部分了解。虽然这种关联对于 1 型和 2 型糖尿病都是正确的，但不同的病理生理过程可能是原因。脂质和其他风险因素确实很重要，而葡萄糖的作用则不太清楚。这种不明确的原因是临床试验并未明确表明强化血糖控制可减少心血管事件。动物模型提供了将糖尿病与动脉粥样硬化增加联系起来的机制，并且已经出现了与高血糖以外因素的重要性一致的证据。我们回顾临床、病理、和动物研究探索患有糖尿病的人类和糖尿病小鼠模型中动脉粥样硬化的发病机制。现在需要加大力度识别葡萄糖以外的风险因素，以防止与糖尿病相关的心血管疾病风险增加。