Diabetic cardiovascular disease

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

People with diabetes have a two to fourfold increased risk of CVD and are up to three times more likely to die after myocardial infarction 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.

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) agonist is recommended in patients with established cardiovascular and/or renal disease.

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.[1]American Diabetes Association. Standards of medical care in diabetes - 2021. Diabetes Care. 2021 Jan;44(Suppl 1):S1-232. https://care.diabetesjournals.org/content/44/Supplement_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), and peripheral arterial disease. This topic will discuss CAD in greatest detail.