Novel treatments for diabetes-associated atherosclerosis

It has long been recognised that diabetic patients have accelerated atherosclerotic disease, particularly due to the underlying inflammatory response associated with the diabetic milieu resulting in atherosclerosis. Accelerated atherosclerosis contributes to the high rates of myocardial infarction and stroke observed in diabetic patients. Whilst current treatment regimes do slow the progression of diabetes-associated atherosclerosis they do not prevent it. This lack of effective treatment, coupled with the increasing prevalence of diabetes worldwide makes identification of novel therapeutic targets imperative. This review will outline recent work from other laboratories and our own with respect to novel therapeutic targets including peptide hormones, such as urotensin II and endothelin I. Furthermore we will outline strategies which target generation of reactive oxygen species (ROS) directly by inhibition of the main enzymatic source of ROS, NADPH oxidase. It is now considered that the innate and adaptive immune system also play an important role in diabetes-associated atherosclerosis. This review will therefore also outline potential novel therapeutic targets within the immune response which contribute to the progression of diabetes-associated atherosclerosis. Ultimately identification of new therapies will lead to a reduction in the burden of cardiovascular disease in diabetes.