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High blood sugar levels can reprogram stem cells, leading to a lasting increase in the risk of fat, cholesterol, and other substances that narrow arteries and restrict blood flow, the research suggests.
Oxford University researchers found that high blood sugar, a hallmark of diabetes, alters stem cells in the bone marrow that turn into white blood cells called macrophages.
As a result, these macrophages become inflammatory and contribute to the development of atherosclerotic plaques that can cause heart attacks.
Our study is the first to show that diabetes causes long-term changes in the immune system, and how this may explain the sustained increase in heart attack risk
Researchers say the findings explain why people with diabetes are at increased risk of heart attack, even after their blood sugar levels have come back under control – a mystery that has troubled doctors for years.
Almost five million people in the UK have diabetes, and adults with the disease are twice as likely to have a heart attack.
Experts say these findings open up new possibilities for treatments that could reduce the risk of heart and circulatory disease in people with diabetes.
Robin Choudhury, professor of cardiovascular medicine in the Radcliffe Department of Medicine at the University of Oxford, led the research.
He said: “Our study is the first to show that diabetes causes long-term changes in the immune system, and how that might explain the sustained increase in heart attack risk.
“We need to change the way we think about and treat diabetes.
“By focusing too narrowly on managing a person’s blood sugar, we are only solving part of the problem.
“Right now, people with diabetes are not receiving effective treatment for their increased risk of heart and circulatory disease.
“These results identify new opportunities to prevent and treat complications of diabetes.”
The team studied the differences in white blood cells in people with and without type 2 diabetes.
They removed the white blood cells from the blood samples and cultured them in an environment with normal glucose levels.
Those of people with type 2 diabetes showed an exaggerated inflammatory response compared to cells of people without.
The researchers also extracted stem cells from the bone marrow of diabetic and non-diabetic mice and transplanted them into mice with normal blood sugar levels.
They found that the bone marrow taken from diabetic mice remembered its exposure to high levels of glucose, and as a result, mice receiving this bone marrow developed almost double the amount of atherosclerotic plaques.
This research could … pave the way for new treatments to reduce heart attack risk for millions of people with diabetes
When the team analyzed this in more detail, they found that those that had developed from stem cells in the bone marrow of diabetic mice had been permanently altered to become more inflammatory.
Professor Sir Nilesh Samani, Medical Director of the British Heart Foundation who funded the research, said, “Although treatments for diabetes have improved, people with diabetes still have a higher risk of heart attack.
“This research may partly explain why this is the case and potentially pave the way for new treatments to reduce the risk of heart attacks for the millions of people living with diabetes.”
The research is published in the journal Circulation.
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