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 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 cardiovascular and/or chronic kidney disease. SGLT2 inhibitors are also indicated in heart failure patients.
Aggressive treatment of hypertension, use of statins, 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. 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. 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. This topic will discuss CAD in greatest detail.
History and exam
Key diagnostic factors
- presence of risk factors
- chest pain
- dyspnoea on exertion
- S3 gallop
Other diagnostic factors
- unilateral weakness, numbness, and/or tingling
- intermittent claudication
- hemisensory loss
- cranial nerve palsies
- limb pain at rest
- diminished/absent lower extremity pulses
- ulcers or gangrene
- peripheral oedema
- smooth shiny skin with hair loss
- cigarette smoking
- poor glycaemic control
- physical inactivity
- overweight and obesity
- elevated C-reactive protein
- family history of cardiovascular disease
- female sex
1st investigations to order
- lipid profile
Investigations to consider
- transthoracic Doppler echocardiogram
- exercise ECG
- exercise imaging test
- pharmacological imaging test
- cardiac MRI or stress cardiac myocardial perfusion imaging
- ankle-brachial index (ABI)
- CT angiography
- coronary angiography
- non-contrast head CT
- brain MRI
- duplex ultrasonography of carotid arteries
- C-reactive protein
- chest x-ray
acute myocardial infarction or unstable angina
highly significant coronary artery disease: without acute myocardial infarction or unstable angina
diabetic cardiovascular disease: stable and/or after intervention
- Unstable angina
- ST-elevation myocardial infarction (STEMI)
- Non-ST-elevation myocardial infarction (NSTEMI)
- Statin use for the primary prevention of cardiovascular disease in adults: preventive medication
- Aspirin use to prevent cardiovascular disease: preventive medication
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