Cardiovascular disease and diabetes: the vulnerable patient

Patients with diabetes exhibit an increased risk for cardiovascular complications, such as acute coronary syndromes, stroke, heart failure, or arrhythmias, as diabetes facilitates changes in the cardiovascular system of these patients. Atherosclerotic lesions have long been recognized as a cause for these events. However, recent findings support the idea that alterations in the circulating blood and the myocardium may be equally or even more important contributors to the development of life-threatening cardiovascular events in patients with diabetes. These alterations in the myocardium, vasculature, and blood characterize the vulnerable patient; the patient with diabetes at high risk for the development of cardiovascular complications. In this overview, we describe the changes that lead to vulnerability and summarize the current understanding of the pathophysiological mechanisms that contribute to the elevated risk for cardiovascular events in patients with diabetes.