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Why does diabetes increase the risk of atherosclerosis even when blood lipid levels are considered?

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The role of coronary artery disease in heart attack — cardiovascular disease This micrograph shows a cross section of a coronary artery narrowed by an atherosclerotic plaque (purplish matter inside the artery). Most heart attacks are caused by the rupture of an atherosclerotic plaque, which triggers the formation of a clot that abruptly blocks blood flow to part of the heart muscle.

Patients with diabetes mellitus experience a significantly higher incidence of atherosclerosis compared to healthy individuals. This increased risk persists even when accounting for the abnormal blood lipid levels often associated with the condition and poor diabetic control.1

The underlying mechanism is believed to involve hyperglycemia—the elevation of blood glucose concentrations—which may directly injure the arterial walls and facilitate the development of atherosclerotic plaques. While diabetes and its complications are frequently aggravated by hyperlipidemia and hypertension, the potential for high blood sugar to damage blood vessels independently highlights why diabetic patients remain at elevated risk for cardiovascular disease regardless of their lipid profile.12