Cardiovascular disease in diabetes.

OBJECTIVES: Obesity and type 2 diabetes (T2D) are major risk factors for cardiovascular disease (CVD), which is often fatal among diabetics. There has been a steady rise in obesity and in associated CVD in the last 2 decades. Despite improvements in clinical and treatment approaches, the prevalence of heart failure (HF) is rising with only minor extension in survival. Obesity and diabetes can potentially increase the risk of HF independent of coronary heart disease and hypertension. Aim of this paper was to systematically review literature in the last 10 years on the association of CVD with obesity and diabetes and to address the key clinical points relevant for diagnosis and risk factor assessment.

METHODS: Original research articles addressing molecular mechanisms, clinical articles and reviews published in the last 10 years in the area of diabetes and heart disease have been collected from different sources including PubMed, Scopus and other databases and critically compiled.

RESULTS: Insulin resistance, common to both T1D and T2D patients, is a major risk factor for cardiovascular events. Association of hyperglycemia with insulin resistance further increases the risk of CVD and heart failure. Even though obesity is an important risk factor for CVD, the risk is mediated mostly through insulin resistance but not body-mass index. The total risk of CVD in T2D patients cannot be explained by traditional risk factors alone and specific metabolic changes also significantly contribute to this.

CONCLUSIONS: The risk from the traditional cardiovascular risk factors for developing heart disease is further aggravated in diabetes. The treatment approach for diabetic patients to prevent cardiovascular complications should aim not only to control insulin resistance but should include lifestyle changes and early pharmacological intervention.