Primary prevention of cardiovascular disease in patients with diabetes

Diabetes is a risk factor for cardiovascular disease.

Patients with type 2 diabetes often also have other risk factors that contribute to cardiovascular disease risk, including older age, elevated blood pressure and dyslipidaemia. Atherosclerotic cardiovascular disease risk should be evaluated as outlined in Estimating atherosclerotic cardiovascular disease risk. However, some patients with diabetes are known to be at high risk of a cardiovascular event; they do not need formal risk stratification before starting treatment to modify cardiovascular disease risk—these are patients with:

  • familial hypercholesterolaemia
  • moderate or severe chronic kidney disease (persistent albuminuria or sustained eGFR less than 45 mL/min/1.73 m2).
Note: Patients with diabetes who have familial hypercholesterolaemia, or moderate or severe chronic kidney disease, are at high cardiovascular disease risk and do not need formal risk estimation before starting treatment.
Optimal management of cardiovascular disease risk factors is particularly important in patients with diabetes (see Cardiovascular disease risk modification). As with individualisation of glycaemic targets (see Glycaemic targets for adults with type 2 diabetes), targets for lipid levels and blood pressure should be individualised; see Lipid modification for patients with diabetes and Blood pressure reduction for patients with diabetes. See also Reducing the risk of cardiovascular disease in patients with diabetic kidney disease.

Patients with type 1 diabetes are also at risk of cardiovascular disease. The risk is increased in patients with a longer duration of diabetes (eg more than 20 years), microvascular complications (eg chronic kidney disease, retinopathy), dyslipidaemia or obesity. However, as onset of type 1 diabetes is usually in younger people, managing cardiovascular disease risk factors in these patients can be complex and should be undertaken by a multidisciplinary diabetes team.

For recommended frequency of screening and monitoring for cardiovascular disease, see Recommended frequency of screening for and monitoring of chronic complications and conditions associated with type 1 diabetes for type 1 diabetes or Recommended frequency of screening for and monitoring of chronic complications and conditions associated with type 2 diabetes for type 2 diabetes.