Abstract Number: Esoc2026a2386 Biomarkers of Atherogenesis and Ischemic Cerebrovascular Events in Patients With Type 2 Diabetes Mellitus

Background and aims Type 2 Diabetes Mellitus (T2D) accelerates atherogenesis and worsens cerebrovascular outcomes. We aimed to analyze hemorheological, endothelial, inflammatory, and genetic biomarkers in patients with significant internal carotid artery (ICA) stenosis, correlating biomarker profiles with T2D status and clinical symptomatology. Methods Patients with >50% ICA stenosis were stratified by T2D status and clinical presentation (symptomatic/asymptomatic) versus controls. All underwent clinical evaluation, duplex scanning, and laboratory testing. We analyzed hemorheological properties; endothelial markers (NO, ADMA, Endothelin-1); inflammatory cytokines (TNF-α, IL-6, CRP, MCP-1); small dense LDL (sdLDL); and genetic polymorphisms (TCF7L2, PPARγ, KCNJ11). Results Patients with T2D, especially with symptomatic ICA stenosis, displayed a severe pro-atherogenic state characterized by impaired hemorheology (increased erythrocyte aggregate strength [γ-dis]), profound endothelial dysfunction (reduced nitric oxide bioavailability, elevated ADMA, Endothelin-1), and heightened systemic inflammation (elevated TNF-α, IL-6, CRP, and MCP-1). Small dense LDL (sdLDL) levels were higher in T2D cohorts and correlated with symptomatic stenosis. The TCF7L2 'T' allele (rs7903146) was more frequent in symptomatic patients. Conclusions T2D exacerbates cerebrovascular disease by intensifying endothelial dysfunction, systemic inflammation, and hemorheological impairment. Our analysis enabled the development of a novel scale to quantify atherogenic potential. This scoring system, integrating key biomarkers like sdLDL and TCF7L2 variants, offers a practical tool for risk stratification and personalized therapy for patients with cerebrovascular pathology and T2D. Conflict of interest Kostiantyn Stepanchenko and Alla Zhidkova nothing to disclose