Diabetic plaque calcification: mechanisms, imaging phenotypes, and clinical implications

Diabetes is associated with a higher burden and heterogeneous phenotypes of plaque calcification, which may influence plaque stability and cardiovascular risk. This review examines diabetic plaque calcification as a dynamic process driven by hyperglycemia and other metabolic disturbances through downstream mechanisms including inflammation, apoptosis, matrix vesicles, and osteogenic transdifferentiation. It highlights the importance of multidimensional imaging assessment beyond calcification burden and discusses current therapeutic limitations and future research directions.