The link between type 2 diabetes and cardiovascular disease
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Understanding the link between type 2 diabetes (T2D) and cardiovascular disease (CVD) may help health care professionals be aware of risks for their patients and make proactive treatment decisions.
Among CVD types, ASCVD poses significant risk for patients with T2Da
ASCVD is the #1 cause of death
and disability among people
with T2D1
People with T2D have a
2–4x higher risk of stroke or MI
vs. those without T2D2-4
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ASCVD-related complications are the most prevalent CV complications among T2D patients5,b
ASCVD=atherosclerotic cardiovascular disease; MI=myocardial infarction; T2D= type 2 diabetes; CI=confidence interval.
aThe ACC defines ASCVD as: a history of an acute coronary syndrome or MI, stable or unstable angina, coronary heart disease with or without revascularization, other arterial revascularization, stroke, or peripheral artery disease assumed to be atherosclerotic in origin.6
bResults from a large retrospective cohort study in patients newly diagnosed with T2D between 2003 and 2014 (n=135,199). Using data from a large U.S. integrated health care system, this study estimated the prevalence and incidence of 13 microvascular and macrovascular complications, including chronic kidney disease, CVD, and all-cause mortality over a 15-year period. Multivariate Cox proportional-hazards models were used to study factors associated with complications. Incidence is defined as incidence rate per 1000 person-years. Combined incidence of ASCVD includes individual incident rates of MI, unstable and stable angina, stroke, and peripheral vascular disease. The incidence rate per 1000 person-years for composite CVD, defined as MI, unstable angina, and stroke, was 11.9, 95% CI (11.7-12.2).5
In patients with T2D, residual CV risk remains despite treatment with standards of care7,c,d
In the TNT study,e even with statin treatment, 14–18% of adults with T2D experienced CV events.8,f
CV=cardiovascular.
cResidual risk is the risk for CV events (including CV death, MI, and stroke) still remaining after patients receive optimal standards of CV risk reduction and T2D care.7
dStandards of care included oral hypoglycemic drugs, basal insulin (or a combination of these 2 therapies), as well as lipid-lowering, antithrombotic, or antiplatelet therapies.
eA subanalysis of the Treating to New Targets (TNT) study, assessing whether benefits from high-dose intensive atorvastatin therapy demonstrated in the TNT study would be similar in patients with T2D and coronary heart disease (CHD). Patients with diabetes and CHD with LDL cholesterol levels of <130 mg/dL (n=1501) were randomized to receive either atorvastatin 10 mg or 80 mg per day. Follow-up was a median of 4.9 years with the primary endpoint being time to first major cardiovascular event (death from CHD, nonfatal non-procedure-related MI, resuscitated cardiac arrest, or fatal or nonfatal stroke).8
fThere was a range in residual risk because a primary CV event occurred in 2 different groups of patients with clinically evident CHD: in 13.8% of patients on atorvastatin 80 mg and in 17.9% of patients on atorvastatin 10 mg.8
Expert guidelines highlight new approach
"…a major paradigm shift beyond glucose control to a broader strategy of comprehensive CV risk reduction.”6
— The American College of Cardiology (ACC)
Coordinating care to support patients
The link between T2D and CVD means providers may collaborate with multiple specialists and other professionals in caring for patients.
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Discussing ASCVD with your diabetes patients
Do your patients know the facts about T2D and ASCVD? This page provides patient-friendly stats and descriptions to help them understand their risks and options.
Additional resources to help people with T2D manage their risk for heart disease and stroke
The American Diabetes Association and the American Heart Association, along with Novo Nordisk and other industry leaders, have joined forces to create Know Diabetes by Heart™. This groundbreaking initiative provides a variety of resources to help combat the public health impact of T2D and CVD, including:
- For professionals: the latest cardiovascular and diabetes science, patient educational and clinical care tools, and quality improvement programs
- For patients: inspiring stories, healthy recipes, expert Q&A series, and more
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References:
- 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(24):2459-2502.
- Almdal T, Scharling H, Jensen JS, Vestergaard H. The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13,000 men and women with 20 years of follow-up. Arch Intern Med. 2004;164(13):1422-1426.
- Fox CS, Coady S, Sorlie PD, et al. Trends in cardiovascular complications of diabetes. JAMA. 2004;292(20):2495-2499.
- 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.
- An J, Nichols GA, Qian L, et al. Prevalence and incidence of microvascular and macrovascular complications over 15 years among patients with incident type 2 diabetes. BMJ Open Diab Res Care. 2021;9(1):e001847.
- Das SR, Everett BM, Birtcher KK, et al. 2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2020;76(9):1117-1145.
- Fruchart J, Davignon J, Hermans MP, et al; Residual Risk Reduction Initiative (R3i). Residual macrovascular risk in 2013: what have we learned? Cardiovasc Diabetol. 2014;13(26):2-17.
- Shepherd J, Barter P, Carmena R, et al; Treating to New Targets Investigators. Effect of lowering LDL cholesterol substantially below currently recommended levels in patients with coronary heart disease and diabetes. Diabetes Care. 2006;29(6):1220-1226.