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Revisiting the links between glycaemia, diabetes and cardiovascular disease
Open accessAbstract
Whilst the interplay between type 2 diabetes and cardiovascular disease (CVD) has been recognised for many years, recent analyses of existing studies have helped refine several aspects of this relationship with relevance to clinical practice. First, recent data demonstrate that fasting glucose is not linearly related to CVD risk in those without diabetes; rather, risk levels escalate (modestly at first) only beyond specific glucose thresholds. Consequently, glucose-based measures may not necessarily enhance CVD risk prediction in those without diabetes. Second, other data confirm that new-onset diabetes is not a post-myocardial infarction 'risk equivalent' state and that, on average, several years of diabetes duration is needed to attain this level of risk. Third, meta-analyses and systemic reviews have confirmed that diabetes increases CVD risk by around twofold on average and this risk is subject to wide variation, being lowest in those newly diagnosed and highest in those with existing vascular disease, proteinuria or renal disease. Fourth, meta-analyses of major glucose-lowering trials suggest that, whilst glucose-lowering lessens vascular risk, risk reduction arising from statins and blood pressure-lowering is greater. Fifth, statins increase diabetes risk, albeit modestly, adding to the emerging concept that some agents that primarily target CVD risk may be diabetogenic, and vice versa. Finally, arising in part from the latter observation, as well as an understanding that CVD and diabetes risk overlap in some individuals but not others, the case for combined CVD/diabetes risk screening (generally using non-fasting lipids and HbA1c), has gained strength.
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“Recent data from a prospective cohort study reported that the risk of acute pancreatitis increased significantly over the quartiles of serum TGs”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [383]
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“Recent data indicate that diabetes per se increases CVD risk about two-fold on average, but the risk is subject to wide variation depending on the population. 342”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [342]
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“Recent data indicate that diabetes per se increases CVD risk about two-fold on average, but the risk is subject to wide variation depending on the population.342”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [342]
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Mach, F., Baigent, C., Catapano, A. L., Koskinas, K. C., Casula, M., Badimon, L., Chapman, M. J., De Backer, G. G., Delgado, V., Ference, B. A., et al. (2019) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2019.08.014 · Cited by 4,854
“Recent data indicate that DM per se increases CVD risk about two-fold on average, but the risk is subject to wide variation depending on the population and current aggressive prophylactic therapy.(401,404) Importantly, those with DM and CAD are at substantially higher CVD risk for future events.”
2016 ESC/EAS Guidelines for the Management of Dyslipidaemias
Catapano, A. L., Graham, I., De Backer, G., Wiklund, O., Chapman, M. J., Drexel, H., Hoes, A. W., Jennings, C. S., Landmesser, U., Pedersen, T. R., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw272 · Cited by 3,162
2016 ESC/EAS Guidelines for the Management of Dyslipidaemias
Catapano, A. L., Graham, I., De Backer, G., Wiklund, O., Chapman, M. J., Drexel, H., Hoes, A. W., Jennings, C. S., Landmesser, U., Pedersen, T. R., et al. (2016) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2016.08.018 · Cited by 1,582
“Recent data indicate that diabetes per se increases CVD risk about two-fold on average, but the risk is subject to wide variation depending on the population.(342) Importantly, those with diabetes and CAD are at substantially higher CVD risk for future events.”
BackgroundMechanisms of Cardiovascular Benefits of Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitors
Lopaschuk, G. D., & Verma, S. (2020) · JACC Basic to Translational Science · doi:10.1016/j.jacbts.2020.02.004 · Cited by 941
“Hyperglycemia itself has been shown to be a weak risk factor for cardiovascular disease (65).”
BackgroundJBS3 Board (2014) · Heart · doi:10.1136/heartjnl-2014-305693 · Cited by 608
Metadata
- Authors
- Sattar, N.
- Affiliations
- University of Glasgow (GB)
- Corresponding author
- Sattar, N.
- ORCID
- Sattar, N.
- Venue
- Diabetologia
- Published
- 2013-01-27
- Volume
- 56
- Issue
- 4
- Pages
- 686-695
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2031027166
- Cited by
- 163
- References
- 52
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 4 · 2023: 8 · 2022: 17 · 2021: 11 · 2020: 14 · 2019: 15 · 2018: 13 · 2017: 10 · 2016: 16 · 2015: 16 · 2014: 25 · 2013: 7
- FWCI
- 3.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Funders
- Amgen
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- Sanofi
- British Heart Foundation
- Diabetes UK
- University College London
- University of Glasgow
- University of Bristol
- Medical Research Council
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, cardiovascular disease, glycemia, fasting blood glucose, cardiovascular risk prediction, new-onset diabetes, myocardial infarction, diabetes duration, proteinuria, kidney disease, vascular disease, glucose-lowering therapy, statins, diabetogenic effect, HbA1c
- MeSH terms
- Blood Glucose, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Humans, Hyperglycemia, Male, Risk Factors, Sex Factors, Triglycerides, Meta-Analysis as Topic, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Diabetes Complications
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