Cardiovascular disease is the #1 cause of morbidity and mortality in people with type 2 diabetes globally1

When you treat patients with type 2 diabetes, you monitor their A1C and CV risk factors closely. However, in patients with diabetes, approximately two-thirds of deaths are attributable to CVD.1

Cardiovascular disease is the #1 cause of morbidity and mortality in people with diabetes globally

What are the risks associated with T2D and CVD?

Compared with people without diabetes:

Patients with diabetes have excess cardiovascular risk

risk of mortality from CV events2,3

4-times greater risk of CAD and stroke

risk of CAD and stroke4

Even if you treat diabetes, there may be residual CV risk


What increases the risk for CV morbidity?

Multiple mechanisms drive accumulated risks for CV morbidity over time in patients with diabetes. Mechanisms that have been implicated as of late include:

  • Atherosclerotic plaques in patients with diabetes tend to be more unstable, leading to greater risk for plaque rupture and thrombosis5
  • Progression of CVD over time6,7 (see chart below)
  • Worsening age-related changes in CV function increase morbidity8
    • In 2011, heart disease or stroke was reported in 28.3% of people with diabetes aged 35 to 64 vs 43.1% aged 65 to 74 and 55.1% aged 75 or older9

Mechanisms that have been implicated as of late include:

  • Atherosclerotic plaques in patients with diabetes tend to be more unstable, leading to greater risk for plaque rupture and thrombosis5
  • Progression of CVD over time6,7
  • Worsening age-related changes in CV function increase morbidity8
    • In 2011, heart disease or stroke was reported in 28.3% of people with diabetes aged 35 to 64 vs 43.1% aged 65 to 74 and 55.1% aged 75 or older9

Linear progression of CVD6,7

Diabetes may accelerate the rate at which atherosclerosis forms and may cause the plaque to be unstable.8

Early endothelial dysfunction and vascular inflammation

Monocyte recruitment and foam cell formation

Development of fatty streaks

Atherosclerotic plaque and ultimately occlusive thrombus formation

Linear progression of CVD6,7

Diabetes may accelerate the rate at which atherosclerosis forms and may cause the plaque to be unstable.7

Early endothelial dysfunction and vascular inflammation

Monocyte recruitment and foam cell formation

Development of fatty streaks

Atherosclerotic plaque and ultimately occlusive thrombus formation

For every 1% increase in A1C, the risk of stroke, CHD, and death is increased10

As the disease progresses the risk of CHD death increases by 86% per decade

Evidence also suggests that CV risk is tied to the severity of diabetes

  • For every 1% increase in A1C, the risk of stroke, CHD, and death is increased 10% to 30%10
  • The Framingham heart study showed that for each decade with diabetes, the 10-year risk of CHD death can be up to 86% greater11
  • CV risk also increases with age, additional comorbidities, and diabetes progression8


The risk of additional comorbidities exists for patients with diabetes

Diabetes12


Comorbid conditions

Hypertension
Dyslipidemia
Obesity
Nonalcoholic fatty liver disease
Obstructive sleep apnea
Cancer
Depression and anxiety disorders

CVD and other complications4,12

Macrovascular

Cerebrovascular disease
CAD
PAD
Heart failure
Myocardial infarctions
Stroke

Microvascular

Nephropathy
Retinopathy
Neuropathy

CVD risk factors12

Major risks include

Hypertension
Dyslipidemia
Advancing age
Smoking
Family history of premature CAD
Albuminuria


Type 2 diabetes and the common comorbid conditions of hypertension and dyslipidemia all carry independent risk for atherosclerotic cardiovascular disease.12

Professional resources

Hear from your peers and access additional resources such as diabetes treatment guidelines

The risk of additional comorbidities exists for patients with diabetes

Diabetes12

Comorbid conditions

Hypertension
Dyslipidemia
Obesity
Nonalcoholic fatty liver disease
Obstructive sleep apnea
Cancer
Depression and anxiety disorders

CVD and other complications4,12

Macrovascular

Cerebrovascular disease
CAD
PAD
Heart failure
Myocardial infarctions
Stroke

Microvascular

Nephropathy
Retinopathy
Neuropathy


CVD risk factors12

Major risks include

Hypertension
Dyslipidemia
Advancing age
Smoking
Family history of premature CAD
Albuminuria

Type 2 diabetes and the common comorbid conditions of hypertension and dyslipidemia all carry independent risk for atherosclerotic cardiovascular disease.12

Professional resources

Watch experts discuss CVD and T2D, and access additional resources such as diabetes treatment guidelines.


CV=cardiovascular; CVD=cardiovascular disease; T2D=type 2 diabetes; CAD=coronary artery disease; PAD=peripheral artery disease; CHD=coronary heart disease

References:

  1. Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. Clinical update: cardiovascular disease in diabetes mellitus. Atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus–mechanisms, management, and clinical considerations. Circulation. 2016;133:2459-2502.
  2. Fitch KV, Blumen HE, Engel T. Cardiovascular event incidence and cost in type 2 diabetes: a commercial and Medicare claim based actuarial analysis. http://us.milliman.com/uploadedFiles/insight/2016/Cardiovascular-Event-Rate-and%20Cost-Diabetes.pdf. 2016; Published November 2016. Accessed February 1, 2017.
  3. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol. 2012;60(24):e44-e164.
  4. Martín-Timón I, Sevillano-Collantes C, Segura-Galindo A, del Cañizo-Gómez FJ. Type 2 diabetes and cardiovascular disease: have all risk factors the same strength? World J Diabetes. 2014;5(4):444-470.
  5. He C, Yang J, Li Y, et al. Comparison of lower extremity atherosclerosis in diabetic and non-diabetic patients using multidetector computed tomography. BMC Cardiovasc Disord. 2014;14(125):1-7.
  6. Rydén L, Grant PJ, Anker SD, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2013;34:3035-3087.
  7. Zeadin MG, Petlura CI, Werstuck GH. Molecular mechanisms linking diabetes to the accelerated development of atherosclerosis. Can J Diabetes. 2013;37:345-350.
  8. Halter JB, Musi N, McFarland Horne F, et al. Diabetes and cardiovascular disease in older adults: current status and future directions. Diabetes. 2014;63:2578-2589.
  9. Centers for Disease Control and Prevention. Percentage of people with diabetes aged 35 years or older reporting heart disease or stroke, by age, United States, 1997-2011. http://www.cdc.gov/diabetes/statistics/cvd/fig4.htm. Updated November 6, 2012. Accessed February 1, 2017.
  10. Chen Y, Lin Y, Chen P, et al. The impact of diabetes mellitus and corresponding HbA1c levels on the future risks of cardiovascular disease and mortality. PLoS One. 2015;10(4):1-12.
  11. Fox CS, Sullivan L, D'Agostino RB Sr, Wilson PWF; the Framingham Heart Study. The significant effect of diabetes duration on coronary heart disease mortality. Diabetes Care. 2004;27(3):704-708.
  12. American Diabetes Association. Standards of medical care in diabetes—2017. Diabetes Care. 2017;40(Suppl1):S1-S135.

CV=cardiovascular; CVD=cardiovascular disease; T2D=type 2 diabetes; CAD=coronary artery disease; PAD=peripheral artery disease; CHD=coronary heart disease

References:

  1. Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. Clinical update: cardiovascular disease in diabetes mellitus. Atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus–mechanisms, management, and clinical considerations. Circulation. 2016;133:2459-2502.
  2. Fitch KV, Blumen HE, Engel T. Cardiovascular event incidence and cost in type 2 diabetes: a commercial and Medicare claim based actuarial analysis. http://us.milliman.com/uploadedFiles/insight/
    2016/Cardiovascular-Event-Rate-and%20Cost-Diabetes.pdf. 2016; Published November 2016. Accessed February 1, 2017.
  3. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol. 2012;60(24):e44-e164.
  4. Martín-Timón I, Sevillano-Collantes C, Segura-Galindo A, del Cañizo-Gómez FJ. Type 2 diabetes and cardiovascular disease: have all risk factors the same strength? World J Diabetes. 2014;5(4):444-470.
  5. He C, Yang J, Li Y, et al. Comparison of lower extremity atherosclerosis in diabetic and non-diabetic patients using multidetector computed tomography. BMC Cardiovasc Disord. 2014;14(125):1-7.
  6. Rydén L, Grant PJ, Anker SD, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2013;34:3035-3087.
  7. Zeadin MG, Petlura CI, Werstuck GH. Molecular mechanisms linking diabetes to the accelerated development of atherosclerosis. Can J Diabetes. 2013;37:345-350.
  8. Halter JB, Musi N, McFarland Horne F, et al. Diabetes and cardiovascular disease in older adults: current status and future directions. Diabetes. 2014;63:2578-2589.
  9. Centers for Disease Control and Prevention. Percentage of people with diabetes aged 35 years or older reporting heart disease or stroke, by age, United States, 1997-2011. http://www.cdc.gov/diabetes/statistics/cvd/fig4.htm. Updated November 6, 2012. Accessed February 1, 2017.
  10. Chen Y, Lin Y, Chen P, et al. The impact of diabetes mellitus and corresponding HbA1c levels on the future risks of cardiovascular disease and mortality. PLoS One. 2015;10(4):1-12.
  11. Fox CS, Sullivan L, D'Agostino RB Sr, Wilson PWF; the Framingham Heart Study. The significant effect of diabetes duration on coronary heart disease mortality. Diabetes Care. 2004;27(3):704-708.
  12. American Diabetes Association. Standards of medical care in diabetes—2017. Diabetes Care. 2017;40(Suppl1):S1-S135.