Diabetes Mellitus and the Heart

Cardiovascular risk

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 male patient with diabetes has 6 years less life expectancy compared to a metabolically healthy male of the same age, and a 60-year-old patient with diabetes and a previous history of a heart attack has 12 years less [1]. 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 [2].

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.

Publication History

Article published online:
31 March 2022

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