Diabetes-related complications form the vast majority of health care costs associated with diabetes, and most of these costs are due to macrovascular disease. Epidemiologic studies of cardiovascular diseases in diabetes are important for the estimation of the magnitude and the nature of the problem, for the identification of the risk factors for cardiovascular diseases in people with diabetes, and for the development of preventive measures. All types of cardiovascular diseases are increased in people with diabetes, most notably coronary heart disease and ischemic stroke that are the leading causes of death in diabetic patients. Hypertension is very common in people with diabetes, in both type 1 and type 2 diabetes, and it multiplies the incidence and mortality of severe cardiovascular diseases in diabetic people. While in non-diabetic people men have much higher risk of cardiovascular diseases than women, in people with diabetes this sex-difference has markedly reduced; women with diabetes lose their relative protection against cardiovascular disease compared with men. Also asymptomatic hyperglycaemia measured by fasting plasma glucose, post-challenge plasma glucose and HbA1c is associated with increased risk of cardiovascular disease. However, when these three glycaemic parameters are analyzed jointly, most of the excess risk is explained by post-challenge (post-prandial) glucose excursions. Already people with impaired glucose tolerance without diabetes have increased risk. In this book chapter, we review epidemiological evidence on cardiovascular diseases in diabetes and hyperglycaemia.
