Cardiovascular Disease Risk and Risk Reduction Strategies in Diabetes Mellitus

Diabetes mellitus, a condition characterized by glucose dysregulation resulting in chronic hyperglycemia, is principally caused by autoimmune destruction of pancreatic beta-cells (type 1 diabetes [T1D]) or insulin resistance with pancreatic beta-cell exhaustion (type 2 diabetes [T2D]). The presence of diabetes confers increased atherosclerotic cardiovascular disease (ASCVD) risk, resulting in significant morbidity and premature mortality. ASCVD manifestations include coronary artery disease, heart failure, atrial fibrillation, and stroke, as well as aortic and peripheral artery diseases. Diabetes-related target organ damage, such as chronic kidney disease, also contributes to ASCVD risk. In this chapter, we discuss the prevalence of diabetes, its relationship to ASCVD risk, screening recommendations, and risk assessment, as well as provide an overview of cardiovascular outcomes trials in diabetes. In adults, most data supporting interventions to improve outcomes are derived from those with T2D. Outcomes trials involving adults with T1D and youth 18 years of age and younger with either T1D or T2D are limited.