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Diabetes Mellitus and the Heart
20 December 2019 (online)
Patients with diabetes mellitus (DM) have a significantly increased risk of developing cardiovascular diseases with their sequelae of acute myocardial infarction, stroke and cardiovascular death. For example, even today a 60-year-old diabetic man has 6 years less life expectancy compared to a non-diabetic man of the same age, and a 60-year-old with diabetes and a previous history of a heart attack has 12 years less . These data highlight the need for targeted risk stratification of patients with diabetes and the consistent treatment of diabetes, associated risk factors and cardiovascular disease.
Patients with diabetes mellitus should be categorized according to their cardiovascular risk into those with very high cardiovascular risk, high cardiovascular risk and moderate cardiovascular risk .
Very high cardiovascular risk
DM and existing cardiovascular disease, or end organ damage, or ≥ 3 risk factors or diabetes duration >20 years
High cardiovascular risk
DM with a diabetes duration >10 years without end organ damage, but with an additional risk factor
Moderate cardiovascular risk
Young patients (type 1 diabetes <35 years; type 2 diabetes
<50 years) with a diabetes duration <10 years without other risk factors
Further risk stratification
In addition to diagnostics for the above-mentioned risk stratification, patients with diabetes and hypertension or clinical suspicion of cardiovascular disease should receive a resting ECG. At present, no convincing data exist to use additional imaging techniques such as echocardiography, stress echocardiography, scintigraphy or MRI in asymptomatic patients with diabetes mellitus. As part of clinical routines, no determination of circulating biomarkers should be carried out as part of risk stratification.
- 1 Di Angelantonio E, Kaptoge S, Emerging Risk Factors C. et al. Association of cardiometabolic multimorbidity with mortality. JAMA 2015; 314: 52-60. doi:10.1001/jama.2015.7008
- 2 Consentino FF, Grant PJ, Aboyans V. et al. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2019; 2019 DOI: 10.1093/eurheartj/ehz486.
- 3 Zinman B, Wanner C, Lachin JM. et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. The New England Journal of Medicine 2015; 373. doi: 10.1056/NEJMoa1504720
- 4 Neal B, Perkovic V, Mahaffey KW. et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 2017; DOI: 10.1056/ NEJMoa1611925.
- 5 Wiviott SD, Raz I, Bonaca MP. et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2018; 380: 347-357
- 6 Marso SP, Daniels GH, Brown-Frandsen K. et al. Liraglutide and cardio- vascular outcomes in type 2 diabetes. N Engl J Med 2016; 375: 311-322. doi: 10.1056/NEJMoa1603827
- 7 Marso SP, Bain SC, Consoli A. et al. Semaglutide and cardiovascular out- comes in patients with type 2 diabetes. N Engl J Med 2016; DOI: 10.1056/ NEJMoa1607141.
- 8 Nichols GA, Gullion CM, Koro CE. et al. The incidence of congestive heart failure in type 2 diabetes: An update. Diabetes Care 2004; 27: 1879-1884
- 9 MacDonald MR, Petrie MC, Varyani F. et al. Impact of diabetes on out- comes in patients with low and preserved ejection fraction heart failure: An analysis of the candesartan in heart failure: Assessment of reduction in mortality and morbidity (CHARM) programme. Eur Heart J 2008; 29: 1377-1385
- 10 Ponikowski P, Voors AA, Anker SD. et al. 2016 ESC Guidelines for the di- agnosis and treatment of acute and chronic heart failure: The task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special con- tribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016; 18: 891-975. doi: 10.1002/ejhf.592
- 11 Kirchhof P, Benussi S, Kotecha D. et al. ESC Guidelines for the ma- nagement of atrial fibrillation developed in collaboration with EACTS: The task force for the management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC Endorsed by the European Stroke Organisation (ESO). Eur Heart J 2016; 2016 DOI: 10.1093/ eurheartj/ehw210.