What is it about?
People with diabetes can develop a dangerous heart condition called silent myocardial ischemia, where the heart receives too little oxygen but causes little or no chest pain. Because warning symptoms are absent, many patients are diagnosed only after serious heart damage has already occurred. This review explains how changes in tiny blood vessels (microvascular dysfunction) and damaged communication between nerves and blood vessels (neurovascular signalling impairment) work together to cause this condition. We describe how long-term high blood sugar damages blood vessels, reduces normal blood flow, affects the function of nerves that detect heart pain, and promotes inflammation and oxidative stress. These changes can hide the body's natural warning signals while continuing to damage the heart. The review also discusses the biological pathways involved, current diagnostic approaches, and potential treatment strategies that may improve early detection and reduce the risk of severe cardiovascular complications in people living with diabetes.
Featured Image
Photo by Ali Hajiluyi on Unsplash
Why is it important?
Silent myocardial ischemia is one of the most challenging cardiovascular complications of diabetes because patients may not experience the chest pain that normally signals a heart problem. As a result, diagnosis is often delayed until significant heart damage has already occurred. This review brings together evidence from vascular biology, neuroscience, and diabetes research to provide a comprehensive explanation of why this condition develops. By highlighting the interaction between microvascular dysfunction and neurovascular signalling impairment, the article offers a broader understanding of disease mechanisms rather than focusing on a single pathway. Improving knowledge of these mechanisms may support earlier diagnosis, encourage more effective risk assessment, and guide the development of future diagnostic tools and therapies aimed at preventing avoidable heart damage in people with diabetes.
Perspectives
As the author, my goal was to combine evidence from different scientific disciplines to explain why many people with diabetes can develop heart damage without experiencing the symptoms that normally prompt medical attention. Rather than examining vascular or neurological mechanisms separately, this review integrates both perspectives to provide a more complete understanding of silent myocardial ischemia. I hope this work encourages further research into early biomarkers, improved screening strategies, and targeted therapeutic approaches that can identify high-risk patients before irreversible cardiac injury occurs. Ultimately, earlier recognition of this condition has the potential to improve patient outcomes and reduce the burden of diabetes-related cardiovascular disease.
Harish Karuppiah Rajasekaran
Kalaignar Karunanidhi Institute of Technology
Read the Original
This page is a summary of: Microvascular dysfunction and neurovascular signalling impairment in diabetic silent myocardial ischemia, Microvascular Research, September 2026, Elsevier,
DOI: 10.1016/j.mvr.2026.104983.
You can read the full text:
Contributors
The following have contributed to this page
