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Cardiovascular disease in type 2 diabetes mellitus: progress toward personalized management
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Cardiovascular diseases (CVDs) are the main cause of death among patients with type 2 diabetes mellitus (T2DM), particularly in low- and middle-income countries. To effectively prevent the development of CVDs in T2DM, considerable effort has been made to explore novel preventive approaches, individualized glycemic control and cardiovascular risk management (strict blood pressure and lipid control), together with recently developed glucose-lowering agents and lipid-lowering drugs. This review mainly addresses the important issues affecting the choice of antidiabetic agents and lipid, blood pressure and antiplatelet treatments considering the cardiovascular status of the patient. Finally, we also discuss the changes in therapy principles underlying CVDs in T2DM.
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“Cardiovascular disease (CVD) remains a significant threat to people with obesity and type 2 diabetes (T2D), with a two to three times higher incidence compared to people without diabetes or obesity [1, 2].”
From Treatment with orforglipron, an oral glucagon-like peptide-1 receptor agonist, is associated with improvements of CV risk biomarkers in participants with type 2 diabetes or obesity without diabetes (2025) · cites this paper as [1]
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“, 2018), responsible for most cardiovascular diseases (CVD) and metabolic complications (Ma et al., 2022).”
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“In clinical practice, substantial fluctuations in hemoglobin A1C (HbA1C, %) and fasting plasma glucose (FPG, mg/dL) levels are frequently observed in patients treated with TZDs [12,13].”
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“T2DM leads to cardiac stiffness, myocardial fibrosis and hypertrophy by multiple mechanisms, such as hyperglycemia, systemic and cardiac insulin resistance, calcium disturbance in cardiomyocytes, inflammation, microvascular dysfunction and so on [21, 22], which put tremendous stress on the heart independently to other…”
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RetractedModern Challenges in Type 2 Diabetes: Balancing New Medications with Multifactorial Care
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“This shift from a glucocentric approach has been crucial in reducing both microvascular and macrovascular complications in diabetic patients [197,198].”
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“In fact, atherosclerotic cardiovascular disease (ASCVD), including myocardial infarction, stroke, and peripheral arterial disease, is two times more likely to occur in patients with T2D [13] and is the leading cause of morbidity and mortality globally [14].”
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“So far, controlling hyperglycemia in T2DM patients is the main way to minimize the risk of diabetic cardiovascular complications, with metformin as typically first-line therapeutic drug, followed by second-line and third-line medication including sulfonylureas, meglitinides, thiazolidinediones (TZDs), α-glucosidase in…”
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“In contrast, T2DM takes place when the body cannot respond fully to insulin, followed by an increase in insulin production and subsequent insulin deficiency, heading to a permanent hyperglycaemia and glucose intolerance [7].”
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“T2DM significantly increases chronic disease risk and is a major risk factor for atherosclerotic cardiovascular disease (ASCVD) [2].”
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“The global burden of CVD is disproportionately borne by patients with DM [2].”
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Shah, M. U., Roebuck, A., Srinivasan, B., Ward, J. K., Squires, P. E., Hills, C. E., & Lee, K. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1499681 · Cited by 15
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“…promoting healthy lifestyles, contributing to higher rates of CVD risk factors and potentially delayed diagnosis and treatment [44–46, 52 Studies reveal that individuals with T2D and hypertension exhibit significantly elevated prevalent CVD and CVD mortality rates compared to those without [39,54].”
Ofori, E. K., Buabeng, A., Amanquah, S. D., Danquah, K. O., Amponsah, S. K., Wormenor, D., Dogodzi, F. K., Adusu‐Donkor, L. X., Bernard, S. K., & Asare‐Anane, H. (2023) · Endocrinology Diabetes & Metabolism · doi:10.1002/edm2.418 · Cited by 12
Vajdi, M., Noshadi, N., Bonyadian, A., Golpour-Hamedani, S., Alipour, B., Tabrizi, F. P. F., Farhangi, M. A., & Askari, G. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e36649 · Cited by 17
“Type 2 diabetes mellitus (T2DM) is a chronic condition characterized by both high blood sugar levels (hyperglycemia) and glucose intolerance, caused by the body ’ s impaired response to insulin, leading to increased insulin production and eventually an insulin deficiency [1].”
BackgroundQaed, E., Aldahmash, W., & Mahyoub, M. A. (2025) · Glycoconjugate Journal · doi:10.1007/s10719-025-10194-x · Cited by 11
“Understanding the systemic manifestations of DM is essential for healthcare providers to provide comprehensive care and prevent further complications in affected individuals [14, 15 ].”
Verma, S., Sabbour, H. M., Alamuddin, N., Alawadi, F., Alkandari, H., Almahmeed, W. A., Assaad-Khalil, S. H., HADDAD, J. A., Lombard, L., Malik, R. A., et al. (2023) · Diabetes Obesity and Metabolism · doi:10.1111/dom.15011 · Cited by 11
“2 Globally, 32%-35% of people with T2D are estimated to have cardiovascular disease (CVD) according to one observational study and a systematic review of the literature 3,4 ; however, of the 60 studies included in the review, only five were from the Middle East and Africa.”
Seksaria, S., Dutta, B. J., Kaur, M., Gupta, G. D., Bodakhe, S. H., & Singh, A. (2023) · Current Diabetes Reviews · doi:10.2174/1573399820666230809152148 · Cited by 12
Nikooyeh, B., Zargaraan, A., Ebrahimof, S., Kalayi, A., Zahedirad, M., Yazdani, H., Rismanchi, M., Karami, T., Khazraei, M., Jafarpour, A., et al. (2023) · European journal of medical research · doi:10.1186/s40001-023-01409-8 · Cited by 11
“A huge body of evidence indicates that replacement of saturated fats with liquid plant oils containing mono- and polyunsaturated fatty acids (MUFAs and PUFAs, respectively) may be accompanied by reduced risk of CVD [13], the primary cause of mortality in T2D [2].”
BackgroundLiu, Y., Liu, J., He, H., Qin, M., Lei, H., Meng, J., Liu, C., Chen, X., Luo, W., & Zhong, S. (2024) · Cardiovascular Diabetology · doi:10.1186/s12933-023-02102-0 · Cited by 11
“Globally, cardiovascular disease affects approximately 32.2% of all persons with T2DM, and the major cause of death for T2DM patients is cardiovascular disease [67, 68].”
BackgroundInfluentialKwan, S. H., & de Mejı́a, E. G. (2024) · Nutrients · doi:10.3390/nu16020329 · Cited by 11
“Neuropathy, nephropathy, retinopathy, cardiovascular disease, stroke, and peripheral vascular disease are common complications experienced by patients with T2D [7,8].”
BackgroundJin, Y., Wan, K., Liu, C., Cheng, W., & Wang, R. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1401342 · Cited by 12
“Individuals with T2D have a substantially heightened predisposition to cardiovascular diseases, exposing them to increased risks of coronary artery disease, myocardial infarction, heart failure, and stroke (4).”
BackgroundGenetic Susceptibility of Type 2 Diabetes and Metabolic Syndrome
Ercegović, V., Džimbeg, M., & Gelemanović, A. (2025) · Diabetology · doi:10.3390/diabetology6020011 · Cited by 15
Tiandho, Y., Afriani, F., Iskandar, J., Gumilar, G., Widianto, E., Muslihati, A., Mahardika, R. G., & Suprijadi (2025) · Microchemical Journal · doi:10.1016/j.microc.2025.115382 · Cited by 11
Lascu, A., Ionică, L. N., Buriman, D. G., Merce, A. P., Deaconu, L., Borza, C., Cretu, O. M., Sturza, A., Muntean, D. M., & Feier, H. B. (2022) · Molecular and Cellular Biochemistry · doi:10.1007/s11010-022-04633-8 · Cited by 10
Ooi, Y., Sarvanandan, T., Hee, N. K. Y., Lim, Q., Paramasivam, S. S., Ratnasingam, J., Vethakkan, S. R., Lim, S. K., & Lim, L. (2024) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2023.0244 · Cited by 11
“Furthermore, a large gap remains in the incidence of ASCVD, CKD and mortality between people with and without T2DM [22,23].”
Zhao, M., Dong, Y., Chen, L., & Shen, H. (2024) · PLoS ONE · doi:10.1371/journal.pone.0305954 · Cited by 13
Aa, B., Serova, M., Chashkina, M. I., Kosharnaia, R. S., Salpagarova, Z. K., Andreev, D. A., & Giverts, I. (2024) · Cardiac failure review · doi:10.15420/cfr.2024.06 · Cited by 10
“41 The risk of developing CHF is 2–5 times higher in patients with T2D than in those without the condition.”
Mazaheri, F., Hoseini, R., & Gharzi, A. (2025) · Scientific Reports · doi:10.1038/s41598-024-81230-3 · Cited by 10
Chen, B., Tao, L., Tian, M., & Ji, Z. (2025) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2025.01.056 · Cited by 10
Bruss, M. D., Elliehausen, C. J., Clark, J. P., Minton, D. M., & Konopka, A. R. (2025) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00432.2025 · Cited by 11
Pescariu, S. A., Elagez, A., Nallapati, B., Bratosin, F., Bucur, A., Negru, A. G., Gaiţă, L., Citu, I. M., Popa, Z. L., & Barata, P. I. (2024) · Pharmaceuticals · doi:10.3390/ph17070929 · Cited by 9
Beyond Blood Sugar: How Left Atrium Strain Predicts Cardiac Outcomes in Type 2 Diabetes
Benchea, L.-C., Anghel, L., Zăvoi, A., Chiuariu, T., Bîrgoan, S.-G., Sascău, R. A., & Stătescu, C. (2024) · Biomedicines · doi:10.3390/biomedicines12081690 · Cited by 9
“Consequently, incorporating STE into routine cardiac evaluation for T2DM patients enhances the detection of early myocardial dysfunction and guides more precise clinical decision-making [3,4].”
BackgroundMethodKong, Y., Luo, Q., Zhang, Q., & Wei, Q. (2025) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-025-01705-9 · Cited by 9
“In individuals with diabetes, CVD is the predominant factor contributing to a heightened risk of premature mortality [7].”
Yang, X., Xue, C., Chen, K.-Y., Gao, D., Wang, H., & Tang, C. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2023.1339744 · Cited by 6
Li, C., Fu, J., Ye, Y., Li, J., He, Y., & Fang, T. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1360525 · Cited by 11
Choi, S., Haam, C. E., Byeon, S., Oh, E. Y., Choi, S. K., & Lee, Y. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms242316873 · Cited by 8
“Normal distribution of the data was confirmed using the Shapiro–Wilk test.”
BackgroundMethodInfluentialKanagala, A., & Harsoda, J. M. (2024) · Cureus · doi:10.7759/cureus.59776 · Cited by 8
“Autonomic dysfunction, which shows up as problems controlling heart rate (HR), blood pressure (BP), and vascular tone [5,6], is a major cause of the higher risk of heart disease in people with T2DM.”
BackgroundZou, Y. L., Zhang, Y., Sun, X., Zhao, W., & Zhang, G. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1660319 · Cited by 8
Antidiabetic actions of GPR55 agonist Abn-CBD and sitagliptin in obese-diabetic high fat fed mice
McCloskey, A. G., Miskelly, M. G., Lafferty, R. A., Flatt, P. R., & McKillop, A. M. (2022) · Biochemical Pharmacology · doi:10.1016/j.bcp.2022.115398 · Cited by 8
Gong, A., Fu, W., Li, H., Guo, N., & Pan, T. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1364519 · Cited by 8
Savvopoulos, S., Hatzikirou, H., & Jelinek, H. F. (2024) · Biomarker Insights · doi:10.1177/11772719231222111 · Cited by 12
“The no diabetes group showed an increased TC, LDL, GSH, GSSG, IL-1 β , IL-10, and MCP-1 compared to the other groups.”
InfluentialJiang, P., Di, Z.-H., Huang, W., & Xie, L. (2024) · Molecules · doi:10.3390/molecules29122747 · Cited by 9
“CVDs are a kind of macrovascular complication and a leading contributor to the mortality of T2DM patients [32].”
BackgroundPark, M., Mun, S., Zhuang, W., Jeong, J., Kim, H. R., Park, H., Han, E.-T., Han, J., Chun, W., Li, H., et al. (2024) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2024.176589 · Cited by 7
Metadata
- Authors
- Ma, C.-X., Ma, X.-N., Guan, C.-H., Li, Y.-D., Mauricio, D., & Fu, S.-B.
- Venue
- Cardiovascular Diabetology
- Published
- 2022-05-14
- Volume
- 21
- Issue
- 1
- Pages
- 74-74
- ISSN
- 1475-2840 (ISSN-L)
- PMC
- PMC9107726
- OpenAlex
- W4280586315
- Cited by
- 464
- References
- 137
- Citations by year
- 2026: 97 · 2025: 153 · 2024: 137 · 2023: 69 · 2022: 8
- FWCI
- 13.31
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Cardiovascular Diabetology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by)
- Lanzhou University Institutional Repository (submittedVersion, cc-by-nc-sa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- the Lanzhou Chengguan District Science and Technology Plan Project (2021-9-19)
- the hospital fund of the First Hospital of Lanzhou University (ldyyyn2020-93)
- the Construction Program of Gansu Provincial Clinical Medical Research Center for Endocrine Diseases (20JR10FA667)
- the Special Funds of Science and Technology Development of the Chinese Central Government to guide Local (1004TCYA032)
- the Gansu Provincial Natural Science Foundation (20JR10RA681)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, cardiovascular disease, personalized medicine, cardiovascular risk management, glycemic control, blood pressure control, lipid-lowering therapy, glucose-lowering agents, antiplatelet therapy, cardiovascular disease prevention, low- and middle-income countries
- MeSH terms
- Blood Glucose, Blood Pressure, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Hypoglycemic Agents, Lipids
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