Diabetic cardiovascular disease

Cardiovascular disease (CVD) is the leading cause of death in people with diabetes.

People with diabetes have up to a fourfold increased risk of stroke and are twice as likely to die after myocardial infarction than people without diabetes.

Regular physical activity, medical nutrition therapy, and smoking cessation or non-initiation are important lifestyle changes for the primary prevention of CVD.

Selected glucose-lowering drugs reduce all-cause and cardiovascular (CV) mortality. Addition of a sodium-glucose cotransporter-2 (SGLT2) inhibitor or a glucagon-like peptide-1 (GLP-1) receptor agonist is strongly recommended in patients with established atherosclerotic CV and/or chronic kidney disease. SGLT2 inhibitors are also indicated in patients with heart failure. Evidence also supports the use of a GLP-1 receptor agonist for primary prevention of stroke in patients at high CV risk.

Aggressive treatment of hypertension, use of lipid-lowering therapy, preventive anticoagulation, and coronary revascularisation (percutaneous transluminal coronary angioplasty or coronary artery bypass surgery during episodes of acute coronary syndrome) can lead to improved survival.

Diabetes mellitus is a group of metabolic diseases characterised by hyperglycaemia, resulting from defects in insulin secretion, insulin action, or both.[1]International Diabetes Federation. IDF diabetes atlas. 10th ed. Brussels, Belgium: International Diabetes Federation; 2021. https://diabetesatlas.org/atlas/tenth-edition The chronic hyperglycaemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.[1]International Diabetes Federation. IDF diabetes atlas. 10th ed. Brussels, Belgium: International Diabetes Federation; 2021. https://diabetesatlas.org/atlas/tenth-edition Diabetes is an established major risk factor for the development of cardiovascular disease, including coronary artery disease (CAD), cerebrovascular disease (stroke or transient ischaemic attack), and peripheral arterial disease.[2]International Diabetes Federation. Diabetes and cardiovascular disease. Brussels, Belgium: International Diabetes Federation; 2016. https://idf.org/our-activities/care-prevention/cardiovascular-disease/cvd-report.html This topic will discuss CAD in greatest detail.