Association of Coronary Microvascular Dysfunction With Cerebrovascular Risk and Cognitive Decline in Patients With Type 2 Diabetes Mellitus: A Cross-Sectional Study

Background: Type 2 diabetes mellitus is associated with microvascular complications that may contribute to both cardiovascular and neurological morbidity. Objective: To evaluate the association of coronary microvascular dysfunction with stroke risk, cognitive decline, and selected hematologic/metabolic biomarkers in patients with type 2 diabetes mellitus without major vessel occlusion. Methods: This analytical cross-sectional study was conducted at the Department of Cardiology, Jinnah International Hospital, Abbottabad, Pakistan, from May 2025 to November 2025. A total of 255 patients with type 2 diabetes mellitus were enrolled using non-probability consecutive sampling. Coronary microvascular dysfunction was assessed through clinical evaluation and available cardiovascular investigations in patients without significant epicardial coronary artery obstruction. Results: The mean age of the participants was 54.7 ± 10.9 years, and 146 (57.3%) were male. Coronary microvascular dysfunction was identified in 112 (43.9%) patients. Cognitive decline was significantly more frequent among patients with coronary microvascular dysfunction than those without it (46.4% vs. 29.4%, p = 0.006). Elevated stroke risk was also higher in patients with coronary microvascular dysfunction (43.8% vs. 23.1%, p = 0.001). Patients with coronary microvascular dysfunction had longer diabetes duration (10.1 ± 4.3 vs. 7.4 ± 3.6 years, p = 0.001), higher glycosylated hemoglobin levels (8.9 ± 1.6% vs. 7.8 ± 1.4%, p = 0.001), higher low-density lipoprotein cholesterol levels (142.1 ± 27.5 vs. 128.4 ± 28.7 mg/dL, p = 0.004), and greater frequencies of hypertension (63.4% vs. 46.9%, p = 0.012) and dyslipidemia (55.4% vs. 41.3%, p = 0.028). Conclusion: Coronary microvascular dysfunction was common among patients with type 2 diabetes mellitus and was significantly associated with cognitive decline, elevated stroke risk, and adverse metabolic profiles. Early identification of microvascular dysfunction may improve vascular risk stratification and guide preventive strategies in diabetic patients.