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This chapter discusses the development, prevention, and management of cardiovascular disease in patients with diabetes mellitus. The number of patients with diabetes is rapidly increasing, and the condition is a major risk factor for the development of cardiovascular disease (see accompanying Hurst’s Central Illustration). A major macrovascular complication of diabetes is coronary heart disease, the leading cause of death in patients with type 2 diabetes. Diabetes-related cardiomyopathy and heart failure is also a concern; compared with individuals who do not have diabetes, risk of heart failure is double in men and five-fold higher in women with diabetes. Additionally, in diabetic patients, stoke-related mortality is almost three-fold higher than in the nondiabetic individuals. Mechanisms of development of cardiovascular disease in patients with diabetes and insulin resistance include hyperglycemia, dyslipidemia, hypercoagulability, inflammation, endothelial dysfunction, and vascular smooth muscle cell proliferation and migration. A major focus in the management of patients with type 1 or type 2 diabetes is the prevention of cardiovascular disease. Strategies known to reduce cardiovascular events in patients with diabetes include diet and lifestyle modification, good glycemic control, effective management of dyslipidemia and hypertension, and antiplatelet therapy.

eFig 28-01

Hurst’s Central Illustration: Vascular Complications in Diabetes Mellitus and Management Strategies.

Microvascular and macrovascular complications of type 1 and type 2 diabetes mellitus. Major microvascular complications include nephropathy and retinopathy. Diabetes also significantly increases the risks of coronary heart disease and acute myocardial infarction, diabetes-related cardiomyopathy and heart failure, and stroke. Management strategies are shown in the red boxes. ACE, angiotensin-converting enzyme; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.


Cardiovascular disease continues to be a major cause of morbidity and mortality in patients with diabetes and prediabetes, and the prevalence of diabetes and prediabetes is expected to exponentially increase over the next 30 years. The global burden of cardiovascular disease has emerged, not only in the developed world but also in low- and middle-income countries. As a result, the major focus in type 1 diabetes patients and type 2 diabetes patients is the prevention of the development of cardiovascular disease. Recently, the American Diabetes Association (ADA) published their recommendations for practice regarding cardiovascular disease risk management in Diabetes Care in January 2016.1


The universally recognized criteria for the diagnosis of prediabetes and diabetes are as follows: (1) a normal glycated hemoglobin should be less than 5.7%, (2) a glycated hemoglobin of 5.7% to 6.4% is considered prediabetes, and (3) a level of 6.5% or higher on two separate occasions indicates diabetes.1 Prediabetes can be diagnosed by a fasting plasma glucose of 100 mg/dL or more (impaired fasting glucose), a postglucose load of 140 to 199 mg/dL (impaired glucose tolerance), or both. Other recognized criteria include a fasting plasma glucose greater than 126 mg/dL ...

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