Cardiovascular disease in type 2 diabetes mellitus and chronic kidney disease: imaging modalities and pathogenetic mechanisms

Patients with cardiovascular diseases and risk factors are regarded a high risk group as a whole. However, the underlying mechanisms between patients might differ significantly. By investigating these processes on a cellular and systemic level, treatment options can be optimized and personalized. In this thesis we demonstrated that patients with type 2 diabetes mellitus and chronic kidney disease are at an increased risk for developing cardiovascular diseases, due to the process of accelerated vascular ageing in terms of arterial inflammation and calcification. In patients with type 2 diabetes mellitus, an increased amount of visceral adipose tissue is related to a rise in arterial inflammation. Additional presence of albuminuria in these patients is an indication for subclinical arterial disease with increased arterial micro-calcification and arterial stiffness. In patients with chronic kidney disease, adipose tissue is characterized by an increased inflammatory state, which promotes vascular disease. We found that metabolic changes, systemic and local inflammation and other biological factors, such as angiogenic factors, result in vascular changes, affecting the development of cardiovascular diseases. Imaging techniques and vascular measurements provide insights into the underlying processes, and are useful for detection and evaluation of de progression of vascular disease. Also lab measurements investigating insulin resistance, cholesterol, kidney function, and albuminuria are important features for risk stratification. By demonstrating that these markers are related to vascular changes, this thesis contributes to personalized medicine and, therefore, in prevention for the development and progression of cardiovascular diseases.