When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Diabetic cardiovascular disease

Last reviewed: 3 Apr 2025
Last updated: 06 Mar 2025

Summary

Definition

History and exam

Key diagnostic factors

  • chest pain
  • dyspnea on exertion
  • hypotension
  • rales
  • S3 gallop
  • hypertension
  • 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 edema
  • smooth shiny skin with hair loss
  • pallor
Full details

Risk factors

  • cigarette smoking
  • hypertension
  • dyslipidemia
  • poor glycemic control
  • physical inactivity
  • overweight and obesity
  • albuminuria
  • chronic kidney disease (CKD)
  • elevated C-reactive protein
  • family history of CVD
  • female sex
  • gestational diabetes
  • mental illness
  • metabolic dysfunction-associated steatotic liver disease (previously nonalcoholic fatty liver disease)
  • atrial fibrillation
Full details

Diagnostic tests

1st tests to order

  • HbA1c
  • lipid profile
Full details

Tests to consider

  • B natriuretic peptide (BNP)/N-terminal prohormone B-natriuretic peptide (NT-proBNP)
  • transthoracic doppler echocardiogram
  • exercise ECG
  • exercise (stress) imaging test
  • pharmacologic (stress) imaging test
  • cardiac MRI or stress cardiac MRI
  • ankle-brachial index (ABI)
  • CT coronary angiography
  • CT coronary calcium scan
  • invasive coronary angiography
  • noncontrast head CT
  • brain MRI
  • duplex ultrasonography of carotid arteries
  • C-reactive protein
  • chest x-ray
Full details

Treatment algorithm

INITIAL

acute myocardial infarction or unstable angina

ACUTE

highly significant coronary artery disease: without acute myocardial infarction or unstable angina

ONGOING

diabetic cardiovascular disease: stable and/or after intervention

Contributors

Authors

Assistant Professor of Medicine (Cardiology)

Section Chief, General Cardiology

Division of Cardiology, Department of Medicine

Northwestern University Feinberg School of Medicine

Bluhm Cardiovascular Institute

Northwestern Memorial Hospital

Chicago

IL

Disclosures

MA is a speaker for Kiniksa Pharmaceuticals in relation to pericarditis/rilonacept.

Dr Mohamed Al-Kazaz would like to gratefully acknowledge Dr Alexander Meyer, Dr Laura Davidson, Dr Charles Davidson, and Dr Leonard E. Egede, the previous contributors to this topic, and would like to gratefully acknowledge the review by Dr Shreenidhi Venuraju, MB BS, MRCP, Wellington Hospital South, UK.

Disclosures

AM, LD, CD, and LE declare that they have no competing interests. LEE is an author of a number of references cited in this topic. SV not disclosed.

Peer reviewers

Assistant Professor

Chicago Medical School

Rosalind Franklin University

Lombard

IL

Disclosures

IM declares that he has no competing interests.

Medical Director

Hines VA Hospital

Hines

IL

Disclosures

DL declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Marx N, Federici M, Schütt K, et al. 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023 Oct 14;44(39):4043-140.Full text  Abstract

American Diabetes Association. Standards of care in diabetes - 2024. Diabetes Care 2024 Jan 1;47(suppl 1):S1-321.Full text

Joseph JJ, Deedwania P, Acharya T, et al. Comprehensive management of cardiovascular risk factors for adults with type 2 diabetes: a scientific statement from the American Heart Association. Circulation. 2022 Mar;145(9):e722-59.Full text  Abstract

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-248.Full text  Abstract

Writing Committee Members; Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. J Am Coll Cardiol. 2022 Jan 18;79(2):e21-129.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Differentials

    • Unstable angina
    • ST-elevation myocardial infarction (STEMI)
    • Non-ST-elevation myocardial infarction (NSTEMI)
    More Differentials
  • Guidelines

    • 2024 guideline for the primary prevention of stroke
    • Newer pharmacological treatments in adults with type 2 diabetes
    More Guidelines
  • Patient information

    Diabetes type 2: should I take insulin?

    Diabetes type 2: what treatments work?

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer