Current trends in epidemiology of cardiovascular disease and cardiovascular risk management in type 2 diabetes

• Published in: Metabolism, clinical and experimental Vol. 123; p. 154838
• Main Authors: Yun, Jae-Seung, Ko, Seung-Hyun
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2021
• Subjects: Cardiovascular disease; Cardiovascular Diseases - complications; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - genetics; Cardiovascular Diseases - prevention & control; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diet therapy; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - genetics; Genetics; Heart Disease Risk Factors; Humans; Hypoglycaemia; Hypoglycemic Agents - therapeutic use; Insulin Resistance; Life Style; Lifestyle modification; Risk Management; Type 2 diabetes; Type 2 diabetes; Cardiovascular disease; Genetics; Insulin resistance; Lifestyle modification; Hypoglycaemia
• DOI: 10.1016/j.metabol.2021.154838
• ISSN: 0026-0495

With the advances in diabetes care, the trend of incident cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM) has been decreasing over past decades. However, given that CVD is still a major cause of death in patients with diabetes and that the risk of CVD in patients with T2DM is more than twice that in those without DM, there are still considerable challenges to the prevention of CVD in diabetes. Accordingly, there have been several research efforts to decrease cardiovascular (CV) risk in T2DM. Large-scale genome-wide association studies (GWAS) and clinical cohort studies have investigated the effects of factors, such as genetic determinants, hypoglycaemia, and insulin resistance, on CVD and can account for the unexplained CV risk in T2DM. Lifestyle modification is a widely accepted cornerstone method to prevent CVD as the first-line strategy in T2DM. Recent reports from large CV outcome trials have proven the positive CV effects of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in patients with high CVD risk. Overall, current practice guidelines for the management of CVD in T2DM are moving from a glucocentric strategy to a more individualised patient-centred approach. This review will discuss the current epidemiologic trends of CVD in T2DM and the risk factors linking T2DM to CVD, including genetic contribution, hypoglycaemia, and insulin resistance, and proper care strategies, including lifestyle and therapeutic approaches. •Despite a decreasing trend in incidence, cardiovascular disease (CVD) still remains the major complication of diabetes.•Evidence supports attributing unexplained CV risk in T2DM to genetic components, hypoglycaemia, and insulin resistance.•Intensive lifestyle modification and nutrient off-loading could be more appropriate than increasing medication dose.•In established CVD, GLP-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors should be considered.