Type diabetes cardiovascular disease -
That's because people with diabetes, particularly Type 2 diabetes, may have the following conditions that contribute to their risk for developing CVD.
For overall cardiovascular health, the American Heart Association recommends at least minutes of moderate-intensity aerobic activity or 75 minutes of vigorous aerobic activity per week or a combination of the two , plus moderate-to high-intensity muscle-strengthening activity at least two days per week.
Read the article: Get Motivated to Get Moving. People with insulin resistance or diabetes and one or more of these risk factors are at even greater risk of heart disease or stroke.
People with diabetes may avoid or delay the development of heart and blood vessel disease by managing their risk factors. Your health care team will do periodic testing to assess whether you have developed any of these risk factors associated with CVD.
Find more tools and resources for managing your diabetes and reducing your risk for cardiovascular disease at KnowDiabetesbyHeart. Written by American Heart Association editorial staff and reviewed by science and medicine advisors.
See our editorial policies and staff. About Diabetes. Diabetes Complications and Risks. Diabetes Risk Factors. Symptoms, Diagnosis and Monitoring of Diabetes. Preventing and Treating Diabetes. Therefore, our results may not apply to children or adolescents.
As well, we dealt only with T2DM; therefore, outcomes may not apply to T1DM or secondary diabetes such as that associated with hemochromatosis or pancreatitis. This study was also challenged by the fact that CVD and its associated conditions are described differently across the literature.
For example, CHD was used interchangeably with CAD or ischemic heart disease. We made every effort to standardize definitions and to group like with like. Furthermore, the types of CVD conditions evaluated varied across articles. Some articles focused on a single outcome, whereas others focused on several outcomes.
As a result, the calculated prevalence rates may represent underestimates, as not all studies reported all outcomes. The types of studies included would have also impacted the overall results of this study.
First, we analyzed only prevalence studies; incidence studies would have different results due to their different perspective. Second, the studies varied both in the method of data collection e.
It is plausible that time-period over which studies were conducted could have impacted the observed prevalence rate of CVD. For example, health status, lifestyle, and treatments have varied over time, which could impact the prevalence rates in the studies using older data.
Overall, it is possible that the prevalence estimates for CVD presented in this article overestimate the prevalence of CVD among patients with T2DM.
First, studies in the medical literature tend to include a sicker population compared to the general T2DM population; therefore, due to self-selection bias, the sample may not be representative of the broader T2DM population and thus lead to an overestimate of the prevalence of CVD.
Second, some of the studies included T2DM patients with an existing CVD diagnosis; therefore, the overall estimate of CVD within these studies could be higher compared to the broader T2DM population.
Finally, only 25 countries were represented in this analysis. Noticeably absent were such countries as Germany, Canada, and Denmark, which all have excellent electronic health data, yet no research studies have been published from them.
Very little has appeared from Africa, the Asian subcontinent or Latin America. More studies from these areas would be welcome. While the scope of this study was to evaluate evidence from peer-reviewed literature, an alternative approach to estimating the prevalence of CVD among patients with T2DM could be to analyze data within existing registries.
This is the first systematic review to synthesize global prevalence rates of CVD, including stroke, MI, angina, heart failure, atherosclerosis and CAD among people with T2DM. The results show that CVD is a major cause of comorbidity and death among patients with T2DM with CAD having the highest prevalence.
There is a paucity of research studies investigating both the prevalence of CVD and risk factors such as obesity among people with T2DM. Given the large burden that CVD exerts on healthcare systems, patients and families around the world, more evidence is needed, ideally in the form of registry studies, to more accurately quantify the global prevalence of CVD among people with T2DM.
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Ren Y, Ren Q, Lu J, Guo X, Huo X, Ji L, Yang X. However, tirzepatide treatment showed a good safety profile in T2DM patients with a high risk of or established CVD, an improved effect on HbA1c in comparison with insulin glargine, and no increases in MACE events compared to insulin glargine [ 79 ].
Available data show an important effect of tirzepatide in terms of HbA1c reduction, weight loss, blood pressure and lipid profiles, with this effect persisting for up to 2 years without increased CVD risk [ 80 ].
Tirzepatide displays primary preventive effects in T2DM with or without CVD risk and may be a well-positioned glucose-lowering agent in future therapeutic regimens.
Dipeptidylpeptidase-4 DPP4 inhibitors have been reported to be neutral with regard to CV outcomes [ 83 ]. However, the use of saxagliptin is associated with an increase in hospitalization for HF [ 84 ], which should be carefully considered. Regarding sulfonylureas, these older agents are inexpensive and widely available and are used as glucose-lowering agents for T2DM patients with CVD.
The UKPDS 33 has confirmed the reduced microvascular risk of sulfonylureas [ 85 ]. In addition, the TOSCA. IT trial confirmed the CV safety of sulfonylureas [ 86 ].
Insulin is a widely extended therapeutic option. A meta-analysis showed that insulin treatment does not increase the risk of CV mortality and myocardial infarction [ 87 ]. A RCT showed that insulin glargine had a neutral effect on CV outcomes [ 88 ], and insulin is widely used to treat T2DM with CVD.
Finally, pioglitazone reduced key secondary macrovascular outcomes in people with T2DM without CV events whose glucose levels were controlled with metformin monotherapy [ 86 ]. Although the PROactive trial failed to show an effect of pioglitazone on the primary composite outcome, this drug resulted in a decrease in the secondary outcome i.
Pioglitazone was also associated with a reduced risk of diabetes, ischemic stroke, and myocardial infarction in patients without diabetes [ 90 ].
An adverse effect of pioglitazone is an increased risk of developing HF, thus pioglitazone should not be used to treat subjects with HF. Therefore, pioglitazone may be used as an add-on treatment to metformin for people with T2DM, as these drugs are widely available and affordable.
The overall medication regimen is roughly similar, with a key focus on metformin, GLP-1 agonists and SGLT2 inhibitors in guidelines for treating CVD in T2DM patients Table 5.
The ADA and the EASD issued an update of their joint recommendations on management of hyperglycemia [ 93 ]. The use of glucose-lowering agents should depend on CV status and T2DM complications.
SGLT2 inhibitors empagliflozin, canagliflozin, and dapagliflozin are associated with a lower risk of HF hospitalization in patients with DM, and are recommended [ 94 ]. More importantly, the largest available systematic review found that SGLT2 inhibitors and GLP-1 receptor agonists lowered all-cause mortality, CV mortality, non-fatal myocardial infarction, and kidney failure.
However, SGLT-2 inhibitors reduced admission to hospital for HF more than GLP-1 receptor agonists, and GLP-1 receptor agonists reduced non-fatal stroke more than SGLT-2 inhibitors which appeared to have no effect [ 67 ]. One RCT has shown the efficacy of metformin in patients with T2DM and HF [ 48 ].
Pioglitazone and saxagliptin are contraindicated in patients with HF or at risk of HF. Although initial data from RCTs of GLP-1 agonists supported a neutral effect on the risk of HF, a recent meta-analysis showed benefits of GLP-1 agonists in HF and diabetes [ 67 ].
However, current guidelines recommend SGLT2 inhibitors as the most suitable treatment in patients with HF. Thus, lowering blood pressure reduces CVD events and microvascular complications and has a favorable effect on CVD outcomes in patients with and without T2DM.
Overall, individualized blood pressure targets are recommended based on CVD status and individual condition Table 6. The ADA and ESC guidelines consistently recommend that initial treatment should involve the drug classes demonstrated to reduce CVD events in patients with T2DM and hypertension, and dual therapy, ACE inhibitors or ARBs in conjunction with dihydropyridine calcium channel blockers or thiazide diuretics are recommended as the first-line treatment[ 41 , 94 ].
For patients with pre-DM, ACE inhibitors or ARBs rather than diuretics or β-blockers are recommended due to the increased risk of new-onset T2DM from diuretics and β-blockers [ 96 ].
Nebivolol does not reduce insulin sensitivity and may be used as an antihypertensive treatment for T2DM patients [ 97 ]. In addition, a double-blind clinical trial has shown that the non-steroidal potent MRA blocker finerenone is efficacious and safe to reduce HF cardiac biomarkers, HF, and albuminuria in T2DM.
Different trials also demonstrated a significant reduction in the primary outcome CV death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for HF in those subjects with T2DM and chronic kidney disease receiving finerenone [ 98 , 99 , ]. Indeed, finerenone significantly improved cardiorenal outcomes in patients with T2DM and kidney disease irrespective of HbA1c levels or insulin use [ ].
Therefore, finerenone should be considered for treatment of patients with T2DM, and this agent is likely to be included as an important treatment option in future updates of current guidelines.
The presence of diabetic dyslipidemia in patients with T2DM is, at least in part, a cause of CVD. Moreover, diabetic dyslipidemia, including elevated triglycerides, low-density lipoprotein cholesterol LDL-C and low high-density lipoprotein cholesterol HDL-C , is associated with increased CV events, especially in high-risk populations [ ].
Accounting for metabolic dyslipidemia in CVD risk stratification is necessary for patients with T2DM [ ]. The ESC established goals for LDL-C based on level of ASCVD risk [ 41 ]. Meta-analysis has shown that statins are the most effective therapy for reducing CV mortality, followed by PCSK9 inhibitors and statins in combination with ezetimibe.
PCSK9 inhibitors effectively reduce MACEs [ ], and statin therapy and add-on treatment with PCSK9 inhibitors or ezetimibe exhibit significant benefit in CVD outcomes [ ]. Fibrate therapy reduces major CVD events [ ], and icosapent ethyl exerts a risk reduction in CVD outcomes beyond lipid-lowering effects [ ].
Overall, these lipid-lowering drugs have CV benefits for secondary prevention. In patients at very high CVD risk, if the LDL-C target is not reached, despite treatment with the maximum tolerated statin dose, combination therapy with ezetimibe or a PCSK9 inhibitor is recommended [ 41 , 94 ].
Statin therapy is contraindicated in patients with pregnancy. T2DM is associated with increased blood thrombogenicity among patients with non-ST elevation acute coronary syndrome [ ].
Platelet P2Y 12 expression is increased fourfold in patients with T2DM, and platelet activation and hypercoagulation in T2DM induce a prothrombotic state and result in an increased risk for CVD events [ ]. The use of aspirin decreases the risk of T2DM among healthy men but not among women [ ].
Low-dose aspirin 81 or mg is neutral for CVD outcomes and increases the risk for gastrointestinal bleeding when used for primary prevention among patients with T2DM [ ].
Contemporary meta-analyses show that the use of aspirin for the primary prevention of CV events needs to be reconsidered [ , ] due to inconsistent CVD benefits and an increased bleeding risk.
Nonetheless, the longest duration of the included trials was just 4 years, and the aspirin effect for longer term use this requires caution, particularly in the post-acute setting [ ]. Meta-analyses showed that early aspirin discontinuation in patients with acute coronary syndrome or percutaneous coronary intervention PCI prevented bleeding events with a neutral effect on CVD outcomes [ ], and the duration of aspirin use 3 months in patients undergoing complex PCI reduced the risk of bleeding without increasing the risk of ischemic events [ ].
Compared with aspirin, P2Y 12 inhibitors reduce the risk of myocardial infarction and stroke in secondary prevention [ ]; thus, P2Y 12 inhibitors may be a useful option for secondary prevention.
P2Y 12 inhibitors include prasugrel, ticagrelor and clopidogrel. Long-term administration of clopidogrel reduces the risk of myocardial infarction or vascular death, and the overall efficacy is superior to that of aspirin [ ]. The benefits of prasugrel and ticagrelor over clopidogrel are even greater, and a reduction in CVD mortality was observed only with ticagrelor [ ].
Ticagrelor exerts similar or greater inhibition of platelet reactivity than prasugrel in diabetic patients with CAD [ ]. For patients after PCI, discontinuation of aspirin within 1 to 3 months with continued P2Y 12 inhibitor monotherapy has a neutral effect on MACE outcomes with a reduction in bleeding [ ].
Rivaroxaban has been shown to reduce the incidence of CVD and an increased risk of bleeding among patients with chronic coronary syndrome [ ]. Compared to warfarin, rivaroxaban reduces stroke, myocardial infarction and MACEs with a lower risk of bleeding among patients with atrial fibrillation and diabetes [ ].
Depending on risk stratification and the risk of bleeding, ESC guidelines recommend that aspirin be considered for primary prevention among patients with a risk of CVD or a diagnosis of CVD and low risk of bleeding [ 41 , 94 ].
Intensive secondary prevention is indicated for patients with T2DM and CVD. Long-term dual antiplatelet therapy is approved for patients with additional high-risk markers. The addition of clopidogrel to aspirin for people with CVD risk or established CVD is associated with a reduction in myocardial infarction and ischemic stroke, however it also leads to an increase in bleeding [ ].
The CV benefit of clopidogrel plus aspirin is reduced in T2DM due to high platelet reactivity, and increasing the dose of clopidogrel and aspirin may enhance antiplatelet effects [ , ]. The benefit of an intensive antiplatelet regimen in these patients is still unclear.
The National Institute for Health and Care Excellence NICE recommends prasugrel plus aspirin for people with ST elevation myocardial infarction after PCI.
Prasugrel or ticagrelor plus aspirin is recommended for people with non-ST elevation myocardial infarction after PCI. Clopidogrel and oral anticoagulants other than prasugrel or ticagrelor for up to one year are recommended for people with acute coronary syndrome and atrial fibrillation after PCI [ ].
For patients with DM and atrial fibrillation or peripheral artery disease, ESC guidelines recommend rivaroxaban therapy [ 94 ]. Rivaroxaban plus aspirin is the preferred long-term antithrombotic regimen for patients with chronic coronary syndrome and high-risk factors [ ].
The current main targets for the control of glycemia, lipids and blood pressure levels in patients according to the most commonly used guidelines should be included as an individualized strategy to prevent CVD in T2DM Tables 2 , 6 and 7.
Although the incidence and mortality rate of T2DM-related CVD have decreased, the prevalence and mortality rate of CVDs in patients with T2DM continues to rise, and most T2DM-related CVDs may be prevented by lifestyle modification and the use of adjunctive drugs. The notion of T2DM-related CVD care has transitioned from comprehensive medical intervention to precision diabetes therapy.
For T2DM patients with established CVD, the GLP-1 agonists, SGLT2 inhibitors, and blood-pressure and lipid-lowering drugs provide an improved precision treatment approach. Accessed 10 Nov World health statistics monitoring health for the SDGs, sustainable development goals.
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Having diabetes means cardikvascular are more likely to Fueling for Performance heart disease. Visease with diabetes diabtes also more likely Football nutrition for match preparation have certain Nutrient-dense ingredients factors, such as high blood pressure or high cholesterolthat increase their chances of having a heart attack or a stroke. If you have diabetes, you can protect your heart and health by managing your blood glucosealso called blood sugar. You can also protect yourself by controlling your high blood pressure and high cholesterol. If you smoke, get help to stop.Video
Ask the Experts: How to Lower Your Risk for Heart Disease if You Have Type 2 DiabetesType diabetes cardiovascular disease -
Blood vessels are also damaged by high cholesterol blood fats and high blood pressure. If your cholesterol is too high, then the extra fat in your blood sticks to the walls of your blood vessels. Over time, this fat hardens and is known as plaque.
Hard plaque can block up the blood vessels, which makes the space narrower and leaves less room for blood to flow. This is called arteriosclerosis or atherosclerosis and is the most common cause of a heart attack.
In the narrower space, blood flow slows down and causes some of the blood cells to group together and clot. If a blood clot breaks away, it will travel through your arteries and veins until it reaches a section too narrow to pass through, making it partially or completely blocked.
Not only does the blood struggle to flow through the blood vessels, but over time atherosclerosis makes the walls of your blood vessels more rigid and less elastic. This can lead to high blood pressure also called hypertension or make high blood pressure worse.
High blood pressure puts extra strain on your blood vessels too. Narrowing of the blood vessels can affect other parts of the body too, like your legs and feet. Find out more about reducing your risk of serious foot problems. Getting your HbA1c, cholesterol and blood pressure checked at least once a year are part of the checks you should have if you have diabetes.
You should be getting access to your diabetes healthcare checks as normal but if you are still experiencing delays or changes to your appointments as an impact of the coronavirus pandemic we advise that you speak to your healthcare team and ask when these will be happening again.
Work with a diabetes care and education specialist for help avoiding health complications such as heart disease. Find out more about how diabetes education can help you take the best care of yourself.
Skip directly to site content Skip directly to page options Skip directly to A-Z link. Español Other Languages. Diabetes and Your Heart. Español Spanish. Minus Related Pages. You can lower your risk for heart disease with lifestyle changes. Get regular checkups to keep track of your heart health.
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Download references. The authors disclose receipt of the following forms of financial support for the research, authorship, and publication of this article: this work was supported by grants from the Lanzhou Chengguan District Science and Technology Plan Project , the Hospital Fund of the First Hospital of Lanzhou University ldyyyn , the Construction Program of Gansu Provincial Clinical Medical Research Center for Endocrine Diseases 20JR10FA , the Gansu Provincial Natural Science Foundation 20JR10RA , and the Special Funds of Science and Technology Development of the Chinese Central Government to Guide Local in TCYA Department of Endocrinology, The First Hospital of Lanzhou University, No.
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Reprints and permissions. Ma, CX. et al. Cardiovascular disease in type 2 diabetes mellitus: progress toward personalized management. Cardiovasc Diabetol 21 , 74 Download citation. Received : 15 March Accepted : 28 April Published : 14 May Anyone you share the following link with will be able to read this content:.
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Search all BMC articles Search. Download PDF. Download ePub. Abstract Cardiovascular diseases CVDs are the main cause of death among patients with type 2 diabetes mellitus T2DM , particularly in low- and middle-income countries.
Introduction Type 2 diabetes mellitus T2DM is a persistent state of hyperglycemia and glucose intolerance that occurs when the body cannot respond fully to insulin, followed by an increase in insulin production and a subsequent insulin deficiency.
Current trends in the epidemiology of cardiovascular disease in T2DM While globally the incidence of CVD among patients with T2DM is 2—3 times higher than among those without T2DM, data suggest a decreasing trend worldwide in the overall prevalence of CVD attributed to T2DM.
Table 1 Prevalence of cardiovascular disease in T2DM Full size table. Prevention of cardiovascular disease in T2DM A focus on efforts to prevent CVD events in high-risk populations might reduce mortality and decrease the economic burden of heart attack and stroke. Table 2 Targets for the control of glycemia Full size table.
Table 3 Cardiovascular benefits of SGLT2 inhibitors Full size table. Table 4 Cardiovascular benefits of GLP-1 agonists Full size table.
Table 5 Recommendations on the use of antidiabetic drugs Full size table. Table 6 Targets for the control of blood pressure Full size table.
Lipid management The presence of diabetic dyslipidemia in patients with T2DM is, at least in part, a cause of CVD. Table 7 Targets for lipid control Full size table. Antiplatelet therapy T2DM is associated with increased blood thrombogenicity among patients with non-ST elevation acute coronary syndrome [ ].
Aspirin The use of aspirin decreases the risk of T2DM among healthy men but not among women [ ]. P2Y 12 inhibitors Compared with aspirin, P2Y 12 inhibitors reduce the risk of myocardial infarction and stroke in secondary prevention [ ]; thus, P2Y 12 inhibitors may be a useful option for secondary prevention.
Rivaroxaban Rivaroxaban has been shown to reduce the incidence of CVD and an increased risk of bleeding among patients with chronic coronary syndrome [ ]. Treatment choice Depending on risk stratification and the risk of bleeding, ESC guidelines recommend that aspirin be considered for primary prevention among patients with a risk of CVD or a diagnosis of CVD and low risk of bleeding [ 41 , 94 ].
Conclusion The current main targets for the control of glycemia, lipids and blood pressure levels in patients according to the most commonly used guidelines should be included as an individualized strategy to prevent CVD in T2DM Tables 2 , 6 and 7.
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