Diabetic cardiovascular disease

Last reviewed: March 2019

Last updated: March 2018

Summary

Cardiovascular disease (CVD) and stroke account for about two-thirds of deaths in people with diabetes.

People with diabetes have a 2- to 4-fold increased risk of CVD and are up to 3 times more likely to die after MI than people without diabetes.

Regular exercise training, individual dietary modification, and smoking cessation or non-initiation are important lifestyle changes for the primary prevention of CVD.

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.

Definition

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. [1] 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 [TIA]), and peripheral arterial disease. This monograph will discuss CAD in greatest detail.

History and exam

Key diagnostic factors

presence of risk factors
chest pain
dyspnoea on exertion
hypotension
rales
S3 gallop
BP >140/90 mmHg
nausea
diaphoresis
tachycardia
indigestion

Full details

Other diagnostic factors

unilateral weakness, numbness, and/or tingling
headache
intermittent claudication
bruits
aphasia
hemisensory loss
cranial nerve palsies
seizures
vertigo
limb pain at rest
diminished/absent lower extremity pulses
ulcers or gangrene
peripheral oedema
smooth shiny skin with hair loss
pallor

Full details

Risk factors

cigarette smoking
hypertension (HTN)
dyslipidaemia
poor glycaemic control
overweight and obesity
physical inactivity
male gender
albuminuria
elevated C-reactive protein
strong family history of CVD

Full details

Diagnostic investigations

1st investigations to order

HbA1c
fasting lipid profile

Full details

Investigations to consider

exercise stress test
treadmill or pharmacological stress echocardiogram
treadmill or pharmacological myocardial perfusion scanning
ankle-brachial index (ABI)
CT angiography
coronary angiography
non-contrast head CT
MRI brain
duplex ultrasonography of carotid arteries
C-reactive protein

Full details

Treatment algorithm

INITIAL

acute MI

ACUTE

highly significant CAD: without acute MI

ONGOING

diabetic CVD: stable and/or after intervention

Contributors

Authors VIEW ALL 

Alexander Meyer, MD

Internal Medicine Resident

Northwestern University

Chicago

Disclosures

AM declares that he has no competing interests.

Laura Davidson, MD

Cardiology Fellow

Northwestern University

Chicago

Disclosures

LD declares that she has no competing interests.

Charles Davidson, MD

Clinical Chief

Division of Cardiology

Medical Director

Bluhm Cardiovascular Institute

Northwestern Memorial Hospital

Professor of Medicine

Northwestern University

Feinberg School of Medicine

Chicago

Disclosures

CD declares that he has no competing interests.

Acknowledgements

Dr Laura Davidson and Dr Charles Davidson would like to gratefully acknowledge Dr Leonard E. Egede, the previous contributor to this monograph, and would like to gratefully acknowledge the review by Dr Shreenidhi Venuraju, MB BS, MRCP, Wellington Hospital South, UK. LEE is an author of a number of references cited in this monograph. SV not disclosed.

Peer reviewers VIEW ALL 

Irfan Moinuddin, MD

Assistant Professor

Chicago Medical School

Rosalind Franklin University

Lombard

Disclosures

IM declares that he has no competing interests.

David Leehey, MD

Medical Director

Hines VA Hospital

Hines

Disclosures

DL declares that he has no competing interests.

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Diabetic cardiovascular disease

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

acute MI

highly significant CAD: without acute MI

diabetic CVD: stable and/or after intervention

Contributors

Authors VIEW ALL 

Alexander Meyer, MD

Disclosures

Laura Davidson, MD

Disclosures

Charles Davidson, MD

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Irfan Moinuddin, MD

Disclosures

David Leehey, MD

Disclosures

Differentials

Guidelines

Patient leaflets

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