Epidemiology of Diabetes Mellitus and Cardiovascular Disease

  • Diana GlovaciEmail author
  • Wenjun Fan
  • Nathan D. Wong
Diabetes and Cardiovascular Disease (N Wong, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Diabetes and Cardiovascular Disease


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.


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.


Cardiovascular disease Diabetes mellitus Epidemiology 


Compliance with Ethical Standards

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.


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

  1. 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. Accessed 9 Aug 2018.
  2. 2.
    National Center for Health Statistics. Mortality multiple cause micro-data files, 2015: public-use data file and documentation: NHLBI tabulations. Accessed 23 Dec 2018.
  3. 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.Google Scholar
  4. 4.
    Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA. 2002;287:2570–81.CrossRefGoogle Scholar
  5. 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.Google Scholar
  6. 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.Google Scholar
  7. 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. 8.
    Dokken B. The pathophysiology of cardiovascular disease and diabetes: beyond blood pressure and lipids. Diabetes Spectr. 2008;21(3):160–5.CrossRefGoogle Scholar
  9. 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.CrossRefGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 12.
    International Diabetes Federation. IDF diabetes atlas. 8th ed. Brussels: International Diabetes Federation; 2017. Accessed 9 Aug 2018.
  13. 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. 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. Scholar
  15. 15.
    Hardy OT, Czech MP, Corvera S. What causes the insulin resistance underlying obesity? Curr Opin Endocrinol Diabetes Obes. 2012;19:81.CrossRefGoogle Scholar
  16. 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.Google Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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.Google Scholar
  19. 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.Google Scholar
  20. 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.CrossRefGoogle Scholar
  21. 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.Google Scholar
  22. 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.Google Scholar
  23. 23.
    OECD. Obesity update. OECD Health Statistics 2014. 2014. Available at: Accessed 9 Aug 2018.
  24. 24.
    Scully T. Diabetes in numbers. Nature. 2012;485:S2–3.CrossRefGoogle Scholar
  25. 25.
    Kaveeshwar SA, Cornwall J. The current state of diabetes mellitus in India. Austr Med J. 2014;7:45–8.CrossRefGoogle Scholar
  26. 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.Google Scholar
  27. 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.CrossRefGoogle Scholar
  28. 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.Google Scholar
  29. 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.CrossRefGoogle Scholar
  30. 30.
    Shurtleff D. The Framingham study: an epidemiologic investigation of cardiovascular disease, section 26. Washington, DC: US Government Printing Office; 1970.Google Scholar
  31. 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.CrossRefGoogle Scholar
  32. 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.
  33. 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.PubMedGoogle Scholar
  34. 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.CrossRefGoogle Scholar
  35. 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.CrossRefGoogle Scholar
  36. 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.CrossRefGoogle Scholar
  37. 37.
    American Diabetes Association. Implications of the United Kingdom prospective diabetes study. Diabetes Care. 2000;23(Suppl 1):S28–32.Google Scholar
  38. 38.
    Fan W. Epidemiology in diabetes mellitus and cardiovascular disease. Cardiovasc Endocrinol. 2017;6(1):8–16.CrossRefGoogle Scholar
  39. 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. 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.Google Scholar
  41. 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.Google Scholar
  42. 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.CrossRefGoogle Scholar
  43. 43.
    Gu K, Cowie CC, Harris MI. Diabetes and decline in heart disease mortality in US adults. JAMA. 1999;281:1291–7.CrossRefGoogle Scholar
  44. 44.
    Kannel WB, McGee DL. Diabetes and cardiovascular disease: the Framingham study. Jama. 1979;241:2035–8.CrossRefGoogle Scholar
  45. 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.Google Scholar
  46. 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. 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.Google Scholar
  48. 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.CrossRefGoogle Scholar
  49. 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.CrossRefGoogle Scholar
  50. 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.CrossRefGoogle Scholar
  51. 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.CrossRefGoogle Scholar
  52. 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.CrossRefGoogle Scholar
  53. 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.CrossRefGoogle Scholar
  54. 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.Google Scholar
  55. 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.CrossRefGoogle Scholar
  56. 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.CrossRefGoogle Scholar
  57. 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.Google Scholar
  58. 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.Google Scholar
  59. 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.CrossRefGoogle Scholar
  60. 60.
    Wenger NK. You’ve come a long way, baby cardiovascular health and disease in women: problems and prospects. Circulation. 2004;109:558–60.CrossRefGoogle Scholar
  61. 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.Google Scholar
  62. 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.CrossRefGoogle Scholar
  63. 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.CrossRefGoogle Scholar
  64. 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.CrossRefGoogle Scholar
  65. 65.
    Fox CS. Cardiovascular disease risk factors, type 2 diabetes mellitus, and the Framingham heart study. Trends Cardiovasc Med. 2010;20(3):90–5. Scholar
  66. 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.Google Scholar
  67. 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.Google Scholar
  68. 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.CrossRefGoogle Scholar
  69. 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.Google Scholar
  70. 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.CrossRefGoogle Scholar
  71. 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.Google Scholar
  72. 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.CrossRefGoogle Scholar
  73. 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.CrossRefGoogle Scholar
  74. 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.
  75. 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.CrossRefGoogle Scholar
  76. 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.
  77. 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. Scholar
  78. 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. 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. CrossRefPubMedGoogle Scholar
  79. 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. CrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Department of Medicine, Heart Disease Prevention Program, Division of CardiologyUniversity of CaliforniaIrvineUSA

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