Cardiovascular Complications in Diabetes Mellitus

Diabetes mellitus accelerates both macrovascular and microvascular disease, markedly increasing the risk of coronary artery disease, heart failure and arrhythmic events. Chronic hyperglycaemia, dyslipidaemia and low-grade inflammation promote endothelial dysfunction, atherogenesis and myocardial fibrosis. Autonomic neuropathy contributes to impaired heart rate variability and predisposes to sudden rhythms disturbances. Diabetic cardiomyopathy, characterised by early diastolic impairment evolving to systolic dysfunction, arises from metabolic derangements and microvascular rarefaction. Patients with diabetes face heightened incidence of myocardial infarction, peripheral arterial disease and stroke, with poorer post-infarction recovery and elevated mortality. Sudden cardiac arrest may be the first manifestation of disease in younger individuals. Global burden is greatest in regions with rising obesity and limited access to preventive care. Intensive glycaemic control, lipid-lowering therapy and blood-pressure management reduce complications, while risk stratification for device therapy and targeted lifestyle intervention remain priorities. Advances in glucose-lowering agents with cardiovascular benefit have reshaped management, but disparities persist, underscoring the need for integrated strategies addressing inflammation, metabolic stress and vascular health.

Research from Nature Portfolio

A multicentre prospective study examined how diagnostic and therapeutic characteristics of diabetes influence the risk of cardiac arrest outside hospital. Patients with type I diabetes and those on insulin therapy exhibited substantially higher risk than those managed with oral agents. A longer duration of diabetes and higher glycated haemoglobin levels were each independently associated with increased incidence of out-of-hospital cardiac arrest. These findings emphasise the prognostic value of granular phenotyping—type of diabetes, treatment modality and glycaemic control—in stratifying sudden-arrest risk and tailoring preventive strategies.

Cardiovascular Complications in Diabetes Mellitus publication trend

The graph below shows the total number of articles in cardiovascular complications in diabetes mellitus across all publications each year (not limited to Nature Index journals).

Technical terms

Out-of-hospital cardiac arrest (OHCA): Sudden cessation of cardiac activity occurring outside a hospital environment.

Sudden cardiac arrest (SCA): Abrupt loss of heart function due to an electrical disturbance.

Implantable cardioverter defibrillator (ICD): A device that detects life-threatening arrhythmias and delivers shocks to restore normal rhythm.

Cardiac resynchronisation therapy (CRT): Synchronous biventricular pacing to improve coordination of ventricular contraction.

Permanent pacemaker (PPM): An implanted system providing electrical stimuli to maintain adequate heart rate.

Ventricular tachyarrhythmia: Rapid abnormal rhythm originating in the ventricles, including ventricular tachycardia and fibrillation.

Glycated haemoglobin (HbA1c): A measure of average blood glucose over the preceding two to three months.

References

1. Implantable cardioverter defibrillator and cardiac resynchronization treatment in people with type 2 diabetes: a comparison with age- and sex matched controls from the general population. Cardiovascular Diabetology (2024).
2. Sudden cardiac death among persons with diabetes aged 1–49 years: a 10-year nationwide study of 14 294 deaths in Denmark. European Heart Journal (2019).
3. Type 2 diabetes and in-hospital sudden cardiac arrest in ST-elevation myocardial infarction in the US. Frontiers in Cardiovascular Medicine (2023).
4. Diagnostic and therapeutic characteristics of diabetes mellitus and risk of out-of-hospital cardiac arrest. Scientific Reports (2022).
5. Diabetes Increases Risk of Cardiovascular Events in Patients Receiving Permanent Pacemaker: A Propensity Score‐Matched Cohort Study. Journal of Diabetes Research (2022).