IMR Press / RCM / Volume 22 / Issue 2 / DOI: 10.31083/j.rcm2202038
Open Access Review
Clinical overview of diabetes mellitus as a risk factor for cardiovascular death
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1 Faculty of Medicine, Imperial College London, SW7 2BX London, UK
2 University Hospital of Birmingham, B15 2TH Birmingham, UK
3 Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, L14 3PE Liverpool, UK
*Correspondence: (Amer Harky)
These authors contributed equally.
Rev. Cardiovasc. Med. 2021, 22(2), 301–314;
Submitted: 18 February 2021 | Revised: 9 April 2021 | Accepted: 16 April 2021 | Published: 30 June 2021
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license (

Global diabetes mellitus prevalence is increasing. Metabolic disorders, such as type 2 diabetes, are associated with abnormal cardiac electrophysiology and increased risk of arrhythmias. Patients with both diabetes types (1 and 2) suffer from sudden cardac death (SCD) as a leading cause of mortality. Cardiovascular death is defined as death attributable to cardiovascular disease (CVD) occurring shortly within the symptom onset. This usually arises from life-threatening ventricular tachyarrhythmias that lead to hemodynamic instability, and subsequent shock and death. A variety of pathways have been suggested that link hypoglycaemia to the development of adverse cardiovascular outcomes, including blood coagulation abnormalities, inflammation, endothelial dysfunction and sympathoadrenal responses. We propose a four-step framework for the optimisation of SCD risk factors in diabetic patients, to include: raising awareness to influence health behaviour, provision of screening programs, use of technology within educational programs to improve patient engagement and effective provision of diabetic community teams.

Diabetes mellitus
Cardiovascular disease
Sudden cardiac death
Fig. 1.
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