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Review
. 2025 Sep 11;26(1):100513.
doi: 10.1016/j.clinme.2025.100513. Online ahead of print.

Diabetes and the heart

Andrew J Sullivan  1 , Andrew Wragg  1 , Krishnaraj Rathod  2
Affiliations
Review

Diabetes and the heart

Andrew J Sullivan et al. Clin Med (Lond). .

Abstract

Diabetes mellitus and cardiac problems frequently coexist, posing significant challenges for both generalists and specialists. This article discusses the common cardiac manifestations of diabetes including coronary artery disease, heart failure and arrythmia, outlining specific diagnostic strategies and management in people with diabetes. We also discuss specific cardiovascular risk stratification strategies in diabetes, as well as glucose-lowering therapies with potential cardiovascular benefits. Ultimately a holistic approach is needed for individuals with co-existent cardiac problems and diabetes, tailoring management strategies to specific patient needs.

Keywords: Cardiovascular diseases; Diabetes mellitus; Heart diseases; Heart failure; Myocardial ischaemia.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Andrew J. Sullivan reports financial support was provided by the Wellcome Trust. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig. 1
The main clinical manifestations of cardiac disease in diabetes. Created in BioRender. Sullivan A. (2025) https://BioRender.com/rdv3rcw.
Fig 2
Fig. 2
SCORE2-Diabetes and QRISK3. CVD, cardiovascular disease; T2DM, type 2 diabetes mellitus; SBP, systolic blood pressure; HDL, high-density lipoprotein; eGFR, estimated glomerular filtration rate; CKD, chronic kidney disease; AF, atrial fibrillation; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus; BMI, body mass index. Created in BioRender. Sullivan A. (2025) https://BioRender.com/qh5byhp.
Fig 3
Fig. 3
Diabetes and atherosclerosis. A variety of pathophysiological mechanisms are involved in diabetes and the development of atherosclerosis. Common processes that diabetes contributes to include endothelial dysfunction and inflammation, with subsequent upregulation of vascular cell adhesion markers and migration of inflammatory cells into vessel walls. Furthermore, epigenetic changes in inflammatory cells leads to changes in immune cell function. Oxidative stress further contributes to inflammation and also contributes to endothelial mesenchymal transition, which is associated with plaque vulnerability. Created in BioRender. Sullivan A. (2025) https://BioRender.com/k62cr16.
Fig 4
Fig. 4
Diabetic cardiomyopathy, proposed mechanisms and pathology. Created in BioRender. Sullivan A. (2025) https://BioRender.com/877xmol.
See this image and copyright information in PMC

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