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Diabetic cardiovascular disease

Last reviewed: 5 Sep 2023
Last updated: 22 Jun 2023



History and exam

Key diagnostic factors

  • chest pain
  • dyspnea on exertion
  • hypotension
  • rales
  • S3 gallop
  • hypertension
  • nausea
  • diaphoresis
  • tachycardia
  • indigestion
More key diagnostic factors

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
Other diagnostic factors

Risk factors

  • cigarette smoking
  • hypertension
  • dyslipidemia
  • poor glycemic control
  • physical inactivity
  • overweight and obesity
  • albuminuria
  • elevated C-reactive protein
  • family history of cardiovascular disease
  • female sex
  • gestational diabetes
More risk factors

Diagnostic investigations

1st investigations to order

  • HbA1c
  • lipid profile
More 1st investigations to order

Investigations to consider

  • transthoracic Doppler echocardiogram
  • exercise ECG
  • exercise imaging test
  • pharmacologic imaging test
  • cardiac MRI or stress cardiac myocardial perfusion imaging
  • ankle-brachial index (ABI)
  • CT angiography
  • coronary angiography
  • noncontrast head CT
  • brain MRI
  • duplex ultrasonography of carotid arteries
  • C-reactive protein
  • chest x-ray
More investigations to consider

Treatment algorithm


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



Mohamed Al-Kazaz, MD

Assistant Professor of Medicine (Cardiology)

Northwestern University Feinberg School of Medicine

Bluhm Cardiovascular Institute

Northwestern Memorial Hospital




MA declares that he has no competing interests.


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.


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

Irfan Moinuddin, MD

Assistant Professor

Chicago Medical School

Rosalind Franklin University




IM declares that he has no competing interests.

David Leehey, MD

Medical Director

Hines VA Hospital




DL declares that he has no competing interests.

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