Diabetes is a chronic disease characterised by high blood glucose levels, a condition known as hyperglycaemia, and due to an altered quantity or function of insulin

Two types can be distinguished: type 1 diabetes and type 2 diabetes

Of these, type II diabetes is the most common form and accounts for around 90% of cases, due to the body’s inability to utilise insulin.

Typically, diabetes occurs after the age of 30-40 years

The main risk factors for developing the disease are:

• increasing age;
• presence of obesity;
• lack of physical activity.

The cardiovascular risk for diabetic patients

The risk of contracting cardiovascular disease is 2 to 4 times higher in people with diabetes than in the rest of the population.

In fact, in industrialised countries, cardiovascular disease is the leading cause of death in patients with diabetes mellitus, generating a vicious circle of reciprocal and increased risk.

The main cardiovascular complications include

• ischaemic heart disease often complicated by heart failure;
• ischaemic stroke and/or haemorrhagic stroke.

High levels of glucose and unused insulin in the blood, together with the very frequent presence of other concomitant risk factors, such as dyslipidaemia, hypertension and obesity, are in turn responsible for the development of

• endothelial dysfunction, where endothelium is the tissue lining the inner surface of blood vessels;
• rapidly evolving premature atherosclerosis, usually affecting the coronary arteries, which are responsible for supplying the heart muscle with blood.

The coronary arteries are small in calibre and tortuous: metabolic alterations, as well as an increased risk of developing thrombotic complications, which diabetes brings with it, also complicate the therapeutic choices in the case of coronary artery disease and subsequent ischaemic heart disease.

The complexity of the picture and the high risk of ineffectiveness of revascularisation strategies, whether surgical or percutaneous, mean that the picture often evolves into full-blown heart failure.

Indeed, it is estimated that 15-25% of heart failure patients have diabetes

The vascular complication with the earliest onset is arteriopathy obliterata in the lower limbs, resulting in ischaemia frequently associated with

• ulceration of the foot
• gangrene;
• significantly increased risk of amputation.

On the cerebrovascular side, however, diabetes is associated with a significantly increased risk of:

• ischaemic stroke;
• stroke recurrence;
• cognitive impairment.

How to reduce cardiovascular risk

And if a correct lifestyle is the first line for the prevention and control of cardiovascular complications in patients with diabetes mellitus, specialists currently have at their disposal a wide spectrum of drugs tested in terms of safety and efficacy, capable of optimising the glycaemic profile with the least occurrence of adverse events.

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Source:

GSD