Cardiovascular risk in diabetes mellitus: Epidemiology, assessment and prevention

Wong, Nathan D.; Sattar, Naveed

doi:10.1038/s41569-023-00877-z

Cited by 495Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Treatment and ManagementCardiovascular Function and Risk Factors

Cardiovascular risk in diabetes mellitus: Epidemiology, assessment and prevention

Wong, Nathan D., Sattar, Naveed·2023·Nature Reviews Cardiology

DOI 10.1038/s41569-023-00877-z

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Abstract

Cardiovascular diseases (CVDs) are the leading causes of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). Secular changes in CVD outcomes have occurred over the past few decades, mainly due to a decline in the incidence of ischaemic heart disease. The onset of T2DM at a young age (<40 years), leading to a greater number of life-years lost, has also become increasingly common. Researchers are now looking beyond established risk factors in patients with T2DM towards the role of ectopic fat and, potentially, haemodynamic abnormalities in mediating important outcomes (such as heart failure). T2DM confers a wide spectrum of risk and is not necessarily a CVD risk equivalent, indicating the importance of risk assessment strategies (such as global risk scoring, consideration of risk-enhancing factors and assessment of subclinical atherosclerosis) to inform treatment. Data from epidemiological studies and clinical trials demonstrate that successful control of multiple risk factors can reduce the risk of CVD events by ≥50%; however, only ≤20% of patients achieve targets for risk factor reduction (plasma lipid levels, blood pressure, glycaemic control, body weight and non-smoking status). Improvements in composite risk factor control with lifestyle management (including a greater emphasis on weight loss interventions) and evidence-based generic and novel pharmacological therapies are therefore needed when the risk of CVD is high.

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Individuals with type 2 diabetes mellitus and prediabetes have a 2- to 7-fold higher risk of developing vascular events, mainly major macrovascular diseases and microvascular diseases.
“Individuals with T2DM and prediabetes have 2- to 7-fold higher risk of developing vascular events,3 mainly including major macrovascular diseases (e.g., myocardial infarction, stroke, or heart failure (HF)) and microvascular diseases (e.g., chronic kidney diseases or retinopathy).”
From Accelerometer-measured physical activity, sedentary behavior, and incidence of macrovascular and microvascular events in individuals with type 2 diabetes mellitus and prediabetes (2025) · cites this paper as [3]
In spite of adequate glycemic control and advanced drug treatment for diabetes, vascular events remain the leading contributors to morbidity and mortality for adults with type 2 diabetes mellitus and prediabetes.
“In spite of adequate glycemic control and advanced drug treatment for diabetes, these vascular events remain the leading contributors to morbidity and mortality for adults with T2DM and prediabetes.3”
From Accelerometer-measured physical activity, sedentary behavior, and incidence of macrovascular and microvascular events in individuals with type 2 diabetes mellitus and prediabetes (2025) · cites this paper as [3]

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Authors: Wong, N. D., & Sattar, N.
Affiliations: University of California, Irvine (US)
University of Glasgow (GB)
Corresponding author: Wong, Nathan D.
Sattar, Naveed
ORCID: Wong, Nathan D.
Sattar, Naveed
Venue: Nature Reviews Cardiology
Publisher: Springer Science and Business Media LLC
Published: 2023-05-16
Volume: 20
Issue: 10
Pages: 685-695
ISSN: 1759-5002 (ISSN-L)
1759-5010
DOI: 10.1038/s41569-023-00877-z
OpenAlex: W4376647457
Semantic Scholar: e7c9f85f71bb751a814f4106e1d5eb6a9abf9fcd
Cited by: 495
References: 124
Citations by year: 2026: 146 · 2025: 213 · 2024: 126 · 2023: 9
FWCI: 17.86
Type: journal article
Language: en
Open access: closed
Licence: www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
Locations: Nature Reviews Cardiology (publishedVersion)
PubMed (publishedVersion)
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 › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Keywords: type 2 diabetes, cardiovascular disease, cardiovascular risk assessment, risk stratification, subclinical atherosclerosis, ectopic fat, heart failure, risk factor control, lifestyle intervention, weight loss, pharmacotherapy, ischemic heart disease
MeSH terms: Heart Disease Risk Factors, Adult, Cardiovascular Diseases, Coronary Artery Disease, Diabetes Mellitus, Type 2, Humans, Risk Factors, Risk Assessment

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