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Type 2 diabetes and cardiovascular disease: what next?

Joseph, Joshua J.a; Golden, Sherita Hilla,b

Current Opinion in Endocrinology, Diabetes and Obesity: April 2014 - Volume 21 - Issue 2 - p 109–120
doi: 10.1097/MED.0000000000000044
LIPIDS: Edited by Annabelle Rodriguez

Purpose of review Cardiovascular disease (CVD) is the leading cause of mortality in type 2 diabetes mellitus (T2DM), and modifying cardiovascular risk through lifestyle intervention and pharmacologic therapy is paramount. This review focuses on recent advances in treatment of classical (traditional) cardiovascular risk factors and highlights the impact of novel risk factors, including sleep disorders, socioeconomic status and chronic psychological stress on CVD in T2DM.

Recent findings Obesity is a substantial cardiovascular risk factor, and recently, large trials of lifestyle and surgical (e.g. gastric bypass) interventions impact on CVD in overweight and obese patients have been reported. Lifestyle intervention including low calorie diet and exercise reduced individual cardiovascular risk factors but did not decrease the rate of long-term cardiovascular events. Bariatric surgery was beneficial in reducing cardiovascular risk factors and long-term cardiovascular events. Sleep insufficiency, poor sleep quality and obstructive sleep apnoea lead to higher CVD and further research is needed to characterize the benefit of treating sleep disorders on long-term cardiovascular events in T2DM. Lastly, socioeconomic status and chronic psychological stress independently have a major impact on increasing CVD in T2DM, and public health policies to reduce this burden will be important to address over the coming decade.

Summary CVD in T2DM is multifactorial and requires a multifaceted approach in reducing known cardiovascular risks at the individual patient level through lifestyle, pharmacotherapy and surgical interventions and at the societal level through public health policies that support reduction in classical and novel cardiovascular risk factors.

aDivision of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine

bDepartment of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA

Correspondence to Dr Sherita Hill Golden, Johns Hopkins University School of Medicine, Division of Endocrinology and Metabolism, 1830 E. Monument Street, Suite 333, Baltimore, MD 21287, USA. Tel: +1 410 502 0993; fax: +1 410 955 8172; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins