Skip to main content

Advertisement

Log in

Epidemiology of Diabetes Mellitus and Cardiovascular Disease

  • Diabetes and Cardiovascular Disease (N Wong, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Diabetes mellitus (DM) has become a rising epidemic in the last century, more pressing in the last few decades with the exponential rise of obesity, and has become one of the leading causes of death worldwide.

Recent Findings

Genetic variants have also been a new field of epidemiology research to determine the underlying genetic component of those risk factors and the association of DM with CVD.

Summary

In light of its significant prevalence, patients remain unaware of their disease progression that arises from genetic and metabolic risk factors. As compared to non-diabetics, those with type 2 DM carry a higher mortality risk from cardiovascular disease (CVD) across different ethnicity groups and sex. The most common cardiovascular manifestations in those with DM include heart failure, peripheral arterial disease, and coronary heart disease. Although DM does predispose patients to CVD, it in fact is not a risk equivalent, but carries significant heterogeneity in risk for CVD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Global Burden of Disease Study 2015. Global burden of disease study 2015 (GBD 2015) results. Seattle: Institute for Health Metrics and Evaluation (IHME), University of Washington; 2016. http://ghdx.healthdata.org/gbd-results-tool. Accessed 9 Aug 2018.

  2. National Center for Health Statistics. Mortality multiple cause micro-data files, 2015: public-use data file and documentation: NHLBI tabulations. https://www.cdc.gov/nchs/nvss/mortality_public_use_data.htm. Accessed 23 Dec 2018.

  3. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation. 2018;137(12):e67–e492.

  4. Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA. 2002;287:2570–81.

    Article  CAS  Google Scholar 

  5. Redberg RF, Greenland P, Fuster V, Pyörälä K, Blair SN, Folsom AR, et al. Prevention Conference VI: Diabetes and cardiovascular disease: writing group III: risk assessment in persons with diabetes. Circulation. 2002;105(18):e144–52.

  6. Mayer-Davis EJ, Lawrence JM, Dabelea D, Divers J, Isom S, Dolan L, et al. Incidence trends of type 1 and type 2 diabetes among youths, 2002–2012. N Engl J Med. 2017;376:1419–29.

  7. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta: US Department of health and human services, Centers for Disease Control and Prevention; 2011.

    Google Scholar 

  8. Dokken B. The pathophysiology of cardiovascular disease and diabetes: beyond blood pressure and lipids. Diabetes Spectr. 2008;21(3):160–5.

    Article  Google Scholar 

  9. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373:1773–9.

    Article  CAS  Google Scholar 

  10. Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002;25:1862–8.

    Article  Google Scholar 

  11. Lee AJ, Hiscock RJ, Wein P, Walker SP, Permezel M. Gestational diabetes mellitus: clinical predictors and long-term risk of developing type 2 diabetes: a retrospective cohort study using survival analysis. Diabetes Care. 2007;30:878–83.

    Article  CAS  Google Scholar 

  12. International Diabetes Federation. IDF diabetes atlas. 8th ed. Brussels: International Diabetes Federation; 2017. http://www.diabetesatlas.org. Accessed 9 Aug 2018.

  13. Centers for Disease Control and Prevention. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta: US Department of Health and Human Services; 2014.

    Google Scholar 

  14. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016;387:1513–30. https://doi.org/10.1016/S0140-6736(16)00618-8.

    Article  Google Scholar 

  15. Hardy OT, Czech MP, Corvera S. What causes the insulin resistance underlying obesity? Curr Opin Endocrinol Diabetes Obes. 2012;19:81.

    Article  CAS  Google Scholar 

  16. [No authors listed]. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. National Institutes of Health. Obes Res. 1998;6(Suppl 2):51S–209S.

  17. Lavie C, Milani R, Ventura H. Obesity and cardiovascular disease risk factor, paradox and impact of weight loss. JACC. 2009;53(21):1925–32.

    Article  Google Scholar 

  18. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289:76–9.

  19. Ko GT, Chan JC, Woo J, Lau E, Yeung VT, Chow CC, et al. Simple anthropometric indexes and cardiovascular risk factors in Chinese. Int J Obes Relat Metab Disord. 1997;21:995–1001.

  20. Oh SW, Shin SA, Yun YH, Yoo T, Huh BY. Cut-off point of BMI and obesity related comorbidities and mortality in middle-aged Koreans. Obes Res. 2004;12:2031–40.

    Article  Google Scholar 

  21. Shin CS, Lee HK, Koh CS, Kim YI, Shin YS, Yoo KY, et al. Risk factors for the development of NIDDM in Yonchon County, Korea. Diabetes Care. 1997;20:1842–6.

  22. Yoon KH, Lee JH, Kim JW, Cho JH, Choi YH, Ko SH, et al. Epidemic obesity and type 2 diabetes in Asia. Lancet. 2006;368:1681–8.

  23. OECD. Obesity update. OECD Health Statistics 2014. 2014. Available at: http://www.oecd.org/els/health-systems/Obesity-Update-2014.pdf. Accessed 9 Aug 2018.

  24. Scully T. Diabetes in numbers. Nature. 2012;485:S2–3.

    Article  CAS  Google Scholar 

  25. Kaveeshwar SA, Cornwall J. The current state of diabetes mellitus in India. Austr Med J. 2014;7:45–8.

    Article  Google Scholar 

  26. Weinstein AR, Sesso HD, Lee IM, Cook NR, Manson JE, Buring JE, et al. Relationship of physical activity vs body mass index with type 2 diabetes in women. JAMA. 2004;292:1188–94.

  27. Lee IM, Rexrode KM, Cook NR, Manson JE, Buring JE. Physical activity and coronary heart disease in women: is ‘no pain, no gain’ passe? JAMA. 2001;285:1447–54.

    Article  CAS  Google Scholar 

  28. Lynch J, Helmrich SP, Lakka TA, Kaplan GA, Cohen RD, Salonen R, et al. Moderately intense physical activities and high levels of cardiorespiratory fitness reduce the risk of non-insulin-dependent diabetes mellitus in middle aged men. Arch Intern Med. 1996;156:1307–14.

  29. Gregg EW, Gerzoff RB, Caspersen CJ, Williamson DF, Narayan KV. Relationship of walking to mortality among US adults with diabetes. Arch Intern Med. 2003;163:1440–7.

    Article  Google Scholar 

  30. Shurtleff D. The Framingham study: an epidemiologic investigation of cardiovascular disease, section 26. Washington, DC: US Government Printing Office; 1970.

    Google Scholar 

  31. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 1991;265:3255–64.

    Article  Google Scholar 

  32. Song Y, Liu X, Zhu X, Zhao B, Hu B, Sheng X, et al. Increasing trend of diabetes combined with hypertension or hypercholesterolemia: NHANES data analysis 1999-2012. Sci Rep. 2016;6:36093. https://doi.org/10.1038/srep36093.

  33. Johnson ML, Pietz K, Battleman DS, Beyth RJ. Prevalence of comorbid hypertension and dyslipidemia and associated cardiovascular disease. Am J Manag Care. 2004;10:926–32.

    PubMed  Google Scholar 

  34. Gress TW, Nieto FJ, Shahar E, Wofford MR, Brancati FL. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. N Engl J Med. 2000;342:905–12.

    Article  CAS  Google Scholar 

  35. UKPDS Group. UK prospective diabetes study 38: tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. BMJ. 1998;317:703–13.

    Article  Google Scholar 

  36. UKPDS Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. BMJ. 1998;317:713–20.

    Article  Google Scholar 

  37. American Diabetes Association. Implications of the United Kingdom prospective diabetes study. Diabetes Care. 2000;23(Suppl 1):S28–32.

    Google Scholar 

  38. Fan W. Epidemiology in diabetes mellitus and cardiovascular disease. Cardiovasc Endocrinol. 2017;6(1):8–16.

    Article  Google Scholar 

  39. Malik S, Wong ND, Franklin S, Pio J, Fairchild C, Chen R. Cardiovascular disease in U.S. patients with metabolic syndrome, diabetes, and elevated C-reactive protein. Diabetes Care. 2005 Jul;28(7):1833–4.

    Google Scholar 

  40. Vu JD, Vu JB, Pio JR, Malik S, Franklin SS, Chen RS, et al. Impact of C-reactive protein on the likelihood of peripheral arterial disease in United States adults with the metabolic syndrome, diabetes mellitus, and preexisting cardiovascular disease. Am J Cardiol. 2005;96(5):655–8.

  41. Malik S, Zhao Y, Budoff M, Nasir K, Blumenthal R, Bertoni A, et al. Coronary artery calcium score for long-term risk classification in individuals with type 2 diabetes and metabolic syndrome from the multi-ethnic study of atherosclerosis. JAMA Cardiol. 2017;2(12):1332–40.

  42. Morrish NJ, Wang SL, Stevens LK, Fuller JH, Keen H. WHO multinational study group. Mortality and causes of death in the WHO multinational study of vascular disease in diabetes. Diabetologia. 2001;44(Suppl 2):S14–21.

    Article  Google Scholar 

  43. Gu K, Cowie CC, Harris MI. Diabetes and decline in heart disease mortality in US adults. JAMA. 1999;281:1291–7.

    Article  CAS  Google Scholar 

  44. Kannel WB, McGee DL. Diabetes and cardiovascular disease: the Framingham study. Jama. 1979;241:2035–8.

    Article  CAS  Google Scholar 

  45. Manson JE, Colditz GA, Stampfer MJ, Willett WC, Krolewski AS, Rosner B, et al. A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women. Arch Intern Med. 1991;151:1141–7.

  46. Wingard DL, Barrett-Connor E. Heart disease and diabetes. In: Harris MI, Cowie CC, Stern MP, Boyko EJ, Rieber GE, Bennett PH, editors. Diabetes in America. 2nd ed. Bethesda: National Institutes of Health; 1995. p. 429–48.

    Google Scholar 

  47. Shah AD, Langenberg C, Rapsomaniki E, Denaxas S, Pujades-Rodriguez M, Gale CP, et al. Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1.9 million people. Lancet Diabetes Endocrinol. 2015;3:105–13.

  48. Wei M, Gaskill SP, Haffner SM, Stern MP. Effects of diabetes and level of glycemia on all-cause and cardiovascular mortality: the San Antonio heart study. Diabetes Care. 1998;21:1167–72.

    Article  CAS  Google Scholar 

  49. Go AS, Mozaffarian D, Roger VL. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129:e28–e292.

    Article  Google Scholar 

  50. Ohira T, Shahar E, Chambless LE, Rosamond WD, Mosley TH, Folsom AR. Risk factors for ischemic stroke subtypes the atherosclerosis risk in communities study. Stroke. 2006;37:2493–8.

    Article  CAS  Google Scholar 

  51. Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative metaanalysis of 102 prospective studies. Lancet. 2010;375:2215–22.

    Article  Google Scholar 

  52. Barbash GI, White HD, Modan M, Van de Werf F. Significance of diabetes mellitus in patients with acute myocardial infarction receiving thrombolytic therapy. J Am Coll Cardiol. 1993;22:707–13.

    Article  CAS  Google Scholar 

  53. Zuanetti G, Latini R, Maggioni AP, Santoro L, Franzosi MG. GISSI-2 investigators. Influence of diabetes on mortality in acute myocardial infarction: data from the GISSI-2 study. J Am Coll Cardiol. 1993;22:1788–94.

    Article  CAS  Google Scholar 

  54. Granger CB, Califf RM, Young S, Candela R, Samara J, Worley S, et al. Outcome of patients with diabetes mellitus and acute myocardial infarction treated with thrombolytic agents. J Am Coll Cardiol. 1993;21:920–5.

  55. Abbud ZA, Shindler DM, Wilson AC, Kostis JB. Myocardial infarction data acquisition system study group. Effect of diabetes mellitus on short-and long-term mortality rates of patients with acute myocardial infarction: a statewide study. Am Heart J. 1995;130:51–8.

    Article  CAS  Google Scholar 

  56. Kanaya AM, Wassel CL, Mathur D, Stewart A, Herrington D, Budoff MJ, et al. Prevalence and correlates of diabetes in South Asian Indians in the 14 Cardiovascular Endocrinology 2017, Vol 6 No 1 United States: findings from the metabolic syndrome and atherosclerosis in South Asians living in America study and the multi-ethnic study of atherosclerosis. Metab Syndr Relat Disord. 2010;8:157–64.

    Article  CAS  Google Scholar 

  57. Misra R, Patel T, Kotha P, Raji A, Ganda O, Banerji M, et al. Prevalence of diabetes, metabolic syndrome, and cardiovascular risk factors in US Asian Indians: results from a national study. J Diabetes Complicat. 2010;24:145–53.

  58. Roth GA, Forouzanfar MH, Moran AE, Barber R, Nguyen G, Feigin VL, et al. Demographic and epidemiologic drivers of global cardiovascular mortality. N Engl J Med. 2015;372:1333–41.

  59. Barrett-Connor E, Wingard DL. Sex differential in ischemic heart disease mortality in diabetics: a prospective population-based study. Am J Epidemiol. 1983;118:489–96.

    Article  CAS  Google Scholar 

  60. Wenger NK. You’ve come a long way, baby cardiovascular health and disease in women: problems and prospects. Circulation. 2004;109:558–60.

    Article  Google Scholar 

  61. Manson JE, Colditz GA, Stampfer MJ, Willett WC, Krolewski AS, Rosner B, et al. A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women. Arch Intern Med. 1991;151:1141–7.

  62. Hu G, Jousilahti P, Qiao Q, Katoh S, Tuomilehto J. Sex differences in cardiovascular and total mortality among diabetic and non-diabetic individuals with or without history of myocardial infarction. Diabetologia. 2005;48:856–61.

    Article  CAS  Google Scholar 

  63. Huxley R, Barzi F, Woodward M. Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ. 2006;332:73–8.

    Article  Google Scholar 

  64. Peters SA, Huxley RR, Woodward M. Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775 385 individuals and 12 539 strokes. Lancet. 2014;383:1973–80.

    Article  Google Scholar 

  65. Fox CS. Cardiovascular disease risk factors, type 2 diabetes mellitus, and the Framingham heart study. Trends Cardiovasc Med. 2010;20(3):90–5. https://doi.org/10.1016/j.tcm.2010.08.001.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Malmberg K, Yusuf S, Gerstein HC, Brown J, Zhao F, Hunt D, et al. OASIS registry investigators. Impact of diabetes on long-term prognosis in patients with unstable angina and non-Q-wave myocardial infarction results of the OASIS (organization to assess strategies for ischemic syndromes) registry. Circulation. 2000;102:1014–9.

  67. Mukamal KJ, Nesto RW, Cohen MC, Muller JE, Maclure M, Sherwood JB, et al. Impact of diabetes on long-term survival after acute myocardial infarction comparability of risk with prior myocardial infarction. Diabetes Care. 2001;24:1422–7.

  68. Juutilainen A, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Type 2 diabetes as a ‘coronary heart disease equivalent’: an 18-year prospective population-based study in Finnish subjects. Diabetes Care. 2005;28:2901–7.

    Article  Google Scholar 

  69. Hu FB, Stampfer MJ, Solomon CG, Liu S, Willett WC, Speizer FE, et al. The impact of diabetes mellitus on mortality from all causes and coronary heart disease in women: 20 years of follow-up. Arch Intern Med. 2001;161:1717–23.

  70. Bulugahapitiya U, Siyambalapitiya S, Sithole J, Idris I. Is diabetes a coronary risk equivalent? Systematic review and meta-analysis. Diabet Med. 2009;26:142–8.

    Article  CAS  Google Scholar 

  71. Wong ND, Glovaci D, Wong K, Malik S, Franklin SS, Wygant G, et al. Global cardiovascular disease risk assessment in United States adults with diabetes. Diab Vasc Dis Res. 2012;9:146–52.

  72. Ford ES. Trends in the risk for coronary heart disease among adults with diagnosed diabetes in the US findings from the national health and nutrition examination survey, 1999–2008. Diabetes Care. 2011;34:1337–43.

    Article  Google Scholar 

  73. Rana JS, Liu JY, Moffet HH, Jaffe M, Karter AJ. Diabetes and prior coronary heart disease are not necessarily risk equivalent for future coronary heart disease events. J Gen Intern Med. 2016;31:387–93.

    Article  Google Scholar 

  74. Malik S, Budoff MJ, Katz R, Blumenthal RS, Bertoni AG, Nasir K, et al. Impact of subclinical atherosclerosis on cardiovascular disease events in individuals with metabolic syndrome and diabetes: the multi-ethnic study of atherosclerosis. Diabetes Care. 2011;34(10):2285–90. https://doi.org/10.2337/dc11-0816.

  75. Ross S, Hertzel G, Eikelboom J, Anand S, Yusufl S, Pare G. Mendelian randomization analysis supports the causal role of dysglycaemia and diabetes in the risk of coronary artery disease. Eur Heart J. 2015;36:1454–62.

    Article  Google Scholar 

  76. Ahmad OS, Morris JA, Mujammami M, Forgetta V, Leong A, Li R, et al. A Mendelian randomization study of the effect of type-2 diabetes on coronary heart disease. Nat Commun. 2015;6:7060. https://doi.org/10.1038/ncomms8060.

  77. Fall T, Xie W, Poon W, Yaghootkar H, Magi R, et al. Using genetic variants to assess the relationship between circulating lipids and type 2 diabetes. Diabetes. 2015;64(7):2676–84. https://doi.org/10.2337/db14-1710.

    Article  CAS  PubMed  Google Scholar 

  78. •• Gottsäter M, Hindy G, Orho-Melander M, Nilsson PM, Melander O. A genetic risk score for fasting plasma glucose is independently associated with arterial stiffness: a Mendelian randomization study. J Hypertens. 2018;36(4):809–14. https://doi.org/10.1097/HJH.0000000000001646 This study demonstrated that the component of genetically elevated fasting glucose, not necessarily genetically elevated risk of type 2 diabetes was associated with arterial stiffness.

    Article  CAS  PubMed  Google Scholar 

  79. •• Ross S, Hertzel G, Pare G. The genetic link between diabetes and atherosclerosis. Can J Cardiol. 2018;34(5):565–74 This article illustrates the potential of genetic studies to understand the relationships among atherosclerotic disease, elevated fasting glucose, and diabetes.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Diana Glovaci.

Ethics declarations

Conflict of Interest

Diana Glovaci and Wenjun Fan declare that they have no conflict of interest.

Nathan D. Wong reports grants from Amgen, Amarin, Boehringer-Ingelheim, and Novo Nordisk, and personal fees from Astra Zeneca.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Diabetes and Cardiovascular Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Glovaci, D., Fan, W. & Wong, N.D. Epidemiology of Diabetes Mellitus and Cardiovascular Disease. Curr Cardiol Rep 21, 21 (2019). https://doi.org/10.1007/s11886-019-1107-y

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-019-1107-y

Keywords

Navigation