Endocrine Abstracts

Cardiovascular disease is the major complication of diabetes that drives mortality and morbidity. Individuals with type 2 Diabetes have a 2-fold increased risk of major cardiovascular events (death, myocardial ischemia and stroke). There is also a 2–4-fold increased risk of heart failure, via mechanisms that are partially independent of underlying coronary disease and myocardial ischemia. Diabetes increases cardiovascular disease via multiple mechanisms including accelerated atherosclerosis, dyslipidemia, increased hypertension, increased thrombosis and increased inflammation. In addition, hyperglycemia and hyperinsulinemia may directly accelerate vascular injury. Additional mechanisms that increase the risk of heart failure in diabetes include altered myocardial energy metabolism, mitochondrial dysfunction, gluco-lipotoxicity and oxidative stress. Some landmark cardiovascular outcomes trials failed to demonstrate a relationship between tight glycemic control and reduction in major adverse cardiovascular complications. More recent trials have indicated that some GLP1R agonists and SGLT2 inhibitors might reduce major adverse cardiovascular outcomes. As such, an evaluation of an individual patients risk for macrovascular disease are now being factored into clinical decision making algorithms regarding the choice of glucose lowering therapies. Given the association between diabetes and atherosclerosis updated guidelines for lipid management emphasize specific guidelines and approaches to lipid management in individuals with diabetes and hypercholesterolemia. Finally, SGLT2 inhibitors and metformin have emerged as agents that might reduce the risk of heart failure in individuals with type 2 diabetes, via mechanisms that are incompletely understood. The presentation will discuss mechanisms that are responsible for the increased risk of cardiovascular disease in type 2 diabetes, particularly those that might be independent of glycemia and discuss the opportunity that this knowledge provides in personalizing therapeutic strategies that may reduce the risk of CVD.