Abstract
Diabetes is a significant health problem worldwide, and its association with cardiovascular disease (CVD) was reported in several studies. Hyperglycemia and insulin resistance seen in diabetes and prediabetes lead to an increase in reactive oxygen species, which triggers intracellular molecular signaling. The resulting prothrombotic state and increase in inflammatory mediators expedite atherosclerotic changes and the development of macrovascular complications. Individuals with diabetes or prediabetes have a higher risk of developing myocardial infarction, stroke, and peripheral artery disease. However, no significant difference in cardiovascular morbidity has been observed with tight glycemic control despite a reduction in some CVD outcomes, and the risk of adverse outcomes such as hypoglycemia was increased. Recently, some GLP-1 receptor agonists and SGLT-2 inhibitors have been shown to reduce cardiovascular events and mortality. In this review we give an overview of the risk and pathogenesis of cardiovascular disease among diabetic and prediabetic patients, as well as the implication of recent changes in diabetes management.
Highlights
Diabetes has been recognized as a global epidemic, with the number of adults with diabetes reaching 422 million and an estimated prevalence of 8.5% worldwide in 2014 [1]
Diabetes is a leading cause of microvascular complications such as nephropathy and retinopathy. It is associated with an accelerating atherosclerosis, and type 2 diabetes mellitus (T2DM) is usually not detected until late in the course of cardiovascular disease (CVD)
Among patients admitted for acute stroke, diabetes was associated with a higher risk of death or functional dependency [32]
Summary
Diabetes has been recognized as a global epidemic, with the number of adults with diabetes reaching 422 million and an estimated prevalence of 8.5% worldwide in 2014 [1]. Diabetes is a leading cause of microvascular complications such as nephropathy and retinopathy. It is associated with an accelerating atherosclerosis, and type 2 diabetes mellitus (T2DM) is usually not detected until late in the course of cardiovascular disease (CVD). The strong association between diabetes and CVD was observed in multiple studies, independently of other traditional cardiovascular risk factors [4,5,6,7]. Being the most common cause of mortality in diabetic patients, CVD mortality accounts for 52% of deaths in T2DM and 44% in type 1 diabetes mellitus (T1DM) [8]. This article attempts to review current understanding of the epidemiology, pathogenesis, and implication of increased CVD risk in diabetic and prediabetic population
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