Cardiovascular disease in patients with type 2 diabetes: beyond traditional risk factors

Abstract

It is estimated by the International Diabetes Federation (IDF), that globally in 2017, 425 million people had diabetes. The vast majority (91%) of these people have type 2 diabetes. The number of people with diabetes is expected to increase to 629 million in the year 2045. Type 2 diabetes is a chronic illness with great negative impact on a person’s quality of life due to severe complications of both the disease and its treatment as well as the associated co-morbidities. In accordance to the burden on individual level, the impact on a global public scale is also great. The global economic burden of type 2 diabetes mellitus in 2015 was estimated to be 1.3 trillion US dollars, with two thirds of these total costs consisting of direct medical costs (857 billion US dollars). Type 2 diabetes mellitus is a well-established risk factor for cardiovascular disease. It was recently shown that approximately a third of all patients with type 2 diabetes are affected by cardiovascular disease. Although great advances have been made in cardiovascular risk management, patients with type 2 diabetes have not benefited as much as patients without diabetes. Compared to individuals without type 2 diabetes, they are still at higher risk of cardiovascular disease. Some of the excess cardiovascular risk can be explained by an increased prevalence of established cardiovascular risk factors in patients with type 2 diabetes, such as hyperglycemia, dyslipidemia, and hypertension. However, these traditional risk factors do not fully explain the excess risk of cardiovascular disease associated with diabetes. The general objectives of this thesis are to further elucidate and understand the observed increased cardiovascular morbidity and mortality risk in patients with type 2 diabetes, by assessing traditional and non-traditional risk factors as potential causes of cardiovascular events in patients with type 2 diabetes.