Prolonged high blood sugar will lead to a metabolic anomaly called non enzymatic glycosylation, which is the sugar binding itself to proteins. This binding can happen anywhere but especially in the coronary arteries (in the heart). That will cause narrowing of the artery very similar to how atherosclerosis cause narrowing of the artery.
The pathogenesis of this disease is so in people with uncontrolled high blood sugars that it isn’t even known as a risk factor, but instead a risk equivalent.
Like I said this can happen in any artery, mainly eyes, kidneys, heart and even nerves.
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