Pulmonary thromboembolism and diabetes mellitus.


  • DAVID Lilia IMSP Institutul de Cardiologie,




Pulmonary thromboembolism, diabetes mellitus


Diabetes mellitus (DM) has an increasing prevalence worldwide, it is a well-known risk factor for cardiovascular diseases. Vascular complications of diabetes are important causes of morbidity and mortality among diabetic patients. Venous thromboembolism (VTE) is the third most common circulatory disorder in Western populations, and pulmonary embolism the third most common cause of death from cardiovascular disease after heart attack and stroke.Diabetes may facilitate thrombosis through activation of the coagulation system and impairing fibrinolysis, thus leading to a hypercoagulable state and is coupled with other prothrombotic factors such as chronic inflammation, enhanced oxidative stress, and decreased expression of protective endothelial factors. Several epidemiological and clinical studies have investigated the correlation between DM and VTE, but the results were conflicting. Some reported a positive association between diabetes and risk of VTE, whereas others failed to detect a significant relationship. This review summarize the current state of the literature on the link between diabetes and risk of VTE.

Author Biography

DAVID Lilia, IMSP Institutul de Cardiologie,

dr. hab. șt. med., conf. cerecetător


Lin X., Xu Y., Pan X. et al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Sci Rep 2020; 10, 14790. https://doi.org/10.1038/s41598-020-71908-9

Turetz M., Sideris A., Friedman O., et al. Epidemiology, Pathophysiology, and Natural History of Pulmonary Embolism. Semin Intervent Radiol. 2018; 35(2): 92–98.

Gariani K., Mavrakanas T., Combescure C., et al. Is diabetes mellitus a risk factor for venous thromboembolism? A systematic review and meta-analysis of case–control and cohort studies. Eur J Intern Med 2016; 28: 52-58

Miguel-Diez J., Muñoz-Rivas N., Jiménez-García R., et al. Type 2 diabetes is associated with a higher incidence of hospitalization for pulmonary embolism in Spain. Respirology 2016; 21: 1277–1284

Movahed M., Hashemzadeh M., Jamal M. The Prevalence of Pulmonary Embolism and Pulmonary Hypertension in Patients With Type II Diabetes Mellitus. Chest 2005; 128:3568–71

Petrauskiene V., Falk M., Waernbaum I., et al. The risk of venous thromboembolism is markedly elevated in patients with diabetes. Diabetologia, 2005; 48: 1017–1021

Stein P., Goldman J., Matta F., et al. Diabetes Mellitus and Risk of Venous Thromboembolism. Am J Med Sci 2009; 337(4):259–64

Chung W.S., Lin C; Kao C. H. Diabetes increases the risk of deep-vein thrombosis and pulmonary embolism. A population-based cohort study . Thromb Haemost 2015; 114: 812–18

Tsai A.W., Cushman M, Rosamond W.D, et al. Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology. Arch Intern Med 2002; 162:1182–1189

Heit J.,, Leibson C.,AshraniA., et al. Is Diabetes Mellitus an Independent Risk Factor for Venous Thromboembolism? A Population-Based Case–Control Study. Arterioscler Thromb Vasc Biol. 2009;29:1399-1405.

Bell E.J.,, Aaron R. Folsom A.R., Lutsey P., et al. Diabetes mellitus and venous thromboembolism: A systematic review and meta-analysis. Diabetes Res Clin Pract 2016;111,10-18

Kannel W.B., McGee D. Diabetes and glucose tolerance as risk factors for cardiovascular diseases: the Framingham study. Diabetes Care 1979; 2:120–126

Piazza G., Goldhaber S., Kroll A., et al. Venous Thromboembolism in Patients with Diabetes Mellitus. Am J Med. 2012; 125 (7): 709 – 16.

Ageno W., Becattini C., Brighton T., et al. Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation 2008; 117:93–102

Bai J., Ding X., Du X., et al Diabetes is associated with increased risk of venous thromboembolism: A systematic review and meta-analysis. Thromb Res 2015;135: 90–95

PengIY-H., Lin Y-Sh., Chen Ch-H., et al. Type 1 diabetes is associated with an increased risk of venous thromboembolism: A retrospective population-based cohort study. PLoS ONE 2020;15(1): e0226997; https://doi.org/10.1371/journal.pone.0226997

Pomero F., Di Minno M., Fenoglio L., et al. Is diabetes a hypercoagulable state? A critical appraisal. Acta Diabetol. 2015;52 (6):1007-1016

Vinik AI, Erbas T, Park TS et al. Platelet dysfunction in type 2 diabetes. Diabetes Care 2001;24:1476–85

Pechlivani N., Ajjan RA. Thrombosis and Vascular Inflammation in Diabetes: Mechanisms and Potential Therapeutic Targets. .Front. Cardiovasc. Med. 2018;5:1-13

Hess K., Alzahrani SH., Mathai M., et al. A novel mechanism for hypofibrinolysis in diabetes: the role of complement C3. Diabetologia 2012;55:1103–1113

Lu D-Y., Huang Ch-C., Huang P-H., et al. Metformin use in patients with type 2 diabetes mellitus is associated with reduced risk of deep vein thrombosis: a non-randomized, pair-matched cohort study. BMC Cardiovascular Disorders 2014, 14:187

de Jager J., Kooy A., Schalkwijk C., et al. Longterm effects of metformin on endothelial function in type 2 diabetes. J Intern Med 2014, 275:59–70

Sobel BE., Hardison R., Genuth S., et al. Profibrinolytic, antithrombotic,antiinflammatory effects of an insulinsensitizing strategy in patients in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. Circulation 2011, 124:695–703.