New research conducted by investigators from Karolinska Institutet found that the longer an individual has type 2 diabetes (T2D), the higher their risk of cardiovascular disease. The study authors, who published their findings in the journal Disease, noted that this increased risk is possibly due to changes in red blood cells and identified a specific molecule as a potential biomarker.1,2
Why Does Type 2 Diabetes Raise Cardiovascular Risk?
The American Heart Association identifies diabetes as a major controllable risk factor for cardiovascular disease, and individuals with T2D face a higher risk of developing and dying from conditions such as heart attacks, strokes, and heart failure than those without diabetes.3
Although diabetes is treatable and glucose levels can be controlled, it still significantly increases the risk of heart disease and stroke, especially in individuals with T2D, due to additional conditions that raise cardiovascular disease risk. These include high blood pressure, abnormal cholesterol and high triglycerides, obesity, lack of physical activity, smoking, and poorly controlled blood sugar.3
This increased risk is largely due to endothelial dysfunction, and the risk worsens with longer disease duration; however, the underlying mechanisms are not yet fully understood.1
How Does Diabetes Duration Affect Endothelial Function?
In previous research, the investigators identified that red blood cells from individuals with T2D impair endothelial function through reduced microRNA (miRNA)-210-3p, which is a small regulatory RNA involved in controlling gene expression, especially under low-oxygen conditions. miRNA was found to play a key role in metabolism, oxidative stress, and blood vessel function.1,2
Furthering this data, researchers investigated if disease duration influences red blood cell-induced endothelial dysfunction and its link to miR-210-3p. The study included both mice of various ages with T2D and patients with newly diagnosed or long-lasting T2D, from one year or greater and less than 7 years, respectively.1,2
Researchers found that red blood cells from older diabetic mice and from individuals with long-standing T2D impaired endothelial function, while those from younger mice or newly diagnosed patients did not. This vascular dysfunction was linked to reduced levels of miR-210-3p, increased oxidative stress, and higher glycerol-3-phosphate dehydrogenase 2 expression, and could be reversed by restoring miR-210-3p.1,2
“What really stands out in our study is that it is not only the presence of type 2 diabetes that matters, but how long you have had the disease. It is only after several years that red blood cells develop a harmful effect on blood vessels,” Zhichao Zhou, associate professor at the Department of Medicine, Solna, Karolinska Institutet, and lead author of the study, said in a news release.2
The findings suggest that disease duration is a key factor in red blood cell-mediated vascular damage and highlight miR-210-3p as a potential biomarker for diabetes-related cardiovascular disease. However, the study authors noted that they are working to investigate if this can be used in larger population studies.1,2
“If we can identify which patients are at greatest risk before vascular damage has already occurred, we can also become better at preventing complications,” Eftychia Kontidou, a doctoral student from the same group and the first author of the study, said in a news release.2
REFERENCES1.Eftychia Kontidou, Aida Collado, Rawan Humoud, Kesavan Manickam, John Tengbom, Tong Jiao, Michael Alvarsson, Jiangning Yang, Linda Mellbin, Ali Mahdi, John Pernow, Zhichao Zhou; Long Duration of Type 2 Diabetes Drives Erythrocyte-Induced Vascular Endothelial Dysfunction: A Link to miRNA-210-3p. Diabetes 2026; db250463. https://doi.org/10.2337/db25-04633. A new study explains the link between long-term diabetes and vascular damage. News release. EurekAlert. January 9, 2026. Accessed January 9, 2025. https://www.eurekalert.org/news-releases/11119633. Cardiovascular Disease and Diabetes. American Heart Association. Updated April 2, 2024. Accessed January 9, 2026. https://www.heart.org/en/health-topics/diabetes/diabetes-complications-and-risks/cardiovascular-disease–diabetes
