Understanding cardiovascular outcomes in type 2 diabetes

Abstract

Although morbidity and mortality from cardiovascular disease are decreasing overall, individuals with type 2 diabetes remain at significantly increased risk. Diabetes-related coronary artery disease currently accounts for a substantial proportion of a cardiologist's workload, and this is likely to increase further with the increasing prevalence of obesity. Patients with type 2 diabetes or metabolic syndrome typically have visceral obesity, which, along with insulin resistance, is becoming an increasingly important risk factor for cardiovascular disease. Visceral adipose tissue is now established as a metabolically active organ, which is thought to contribute to vascular disease by secreting a range of cytokines and other pro-inflammatory mediators. Furthermore, evidence is accumulating that the long period of insulin resistance, which typically precedes the onset of diabetes , may be an important factor underlying the development of atherosclerosis. The continuing tendency toward adverse cardiovascular outcomes in those with type 2 diabetes, despite optimal management of conventional risk factors, argues for intensified efforts to prevent or delay the development of atherosclerotic disease. With the prevalence of obesity and type 2 diabetes continuing to increase, it is essential to focus treatment strategies on the pre-diabetes phase in order to significantly impact on cardiovascular event rates in the future.