The burden of cardiovascular disease (CVD) in patients with diabetes has long been recognised.

Learning objectives

After reading this article, pharmacists should be able to:

  • Describe the significance of cardiovascular disease as a macrovascular complication of diabetes
  • Summarise patient and medicine factors to be considered when selecting diabetes medicines
  • Explain the results of recent cardiovascular safety trials and their impact on diabetes management.

Competencies (2016) addressed: 1.1, 1.3, 1.5, 3.5

Accreditation number: CAP1907B

As CVD is the leading cause of death and morbidity in patients with type 2 diabetes, managing cardiovascular risk is a key priority.2 The United States Food and Drug Administration (FDA) has mandated that cardiovascular safety of new diabetes medicines be investigated. Several trials unexpectedly showed not only cardiovascular safety, but also additional cardiovascular and renal benefits over placebo. These results are creating a paradigm shift in diabetes management. Cardiovascular and renal benefits are now considered in the medicine decision pathway.

Cardiovascular disease in diabetes

The burden of CVD in people with diabetes is significant. Almost two in three adults with type 2 diabetes report co-existing CVD.2 CVD, specifically atherosclerotic disease, is the leading cause of death and disability in people with type 2 diabetes.1 Coronary heart disease, stroke and peripheral vascular disease typically appear earlier in patients with type 2 diabetes (by approximately 14.6 years). These complications are also more severe than in people without diabetes.1

The pathophysiology behind the diabetes and CVD link is complex. It is thought to derive partly from greater plaque burden, increased complex coronary lesions, and more diffuse multi-vessel disease.3 Diabetes confers more than double the risk of all-cause mortality relative to people without diabetes. It is the risk equivalent of having had a myocardial infarction or stroke.2,4,5

Both microvascular (e.g. diabetic retinopathy, diabetic nephropathy, diabetic neuropathy) and macrovascular (e.g. CVD) complications are serious manifestations of progressive diabetes. However, macrovascular complications are responsible for almost a third of all deaths in people with diabetes and occur far more frequently than fatal microvascular events.2,6 Of note is the finding that congestive heart failure is becoming the leading cause of death in people with diabetes.2 Those with co-existing CVD and diabetes have more than double the risk of mortality compared with people with diabetes or prior myocardial infarction alone.7

Test your knowledge on this article’s assessment questions here to earn up to 2 Group 2 CPD credits.