Abstract

Diabetes mellitus is a major global public health challenge and a powerful independent risk factor for 
cardiovascular disease (CVD), which remains the leading cause of morbidity and mortality among individuals with 
diabetes. This narrative review synthesizes current evidence on the epidemiology, pathophysiology, clinical 
manifestations, diagnostic strategies, and therapeutic approaches linking diabetes to cardiovascular complications. 
Central mechanisms include chronic hyperglycemia, insulin resistance, dyslipidemia, inflammation, oxidative 
stress, and endothelial dysfunction, which collectively accelerate atherosclerosis and promote cardiac and vascular 
remodeling. The review examines the spectrum of cardiovascular complications associated with diabetes, including 
coronary artery disease, heart failure, cardiomyopathy, cerebrovascular disease, and peripheral arterial disease, 
highlighting differences between type 1 and type 2 diabetes and across age groups and special populations. 
Advances in cardiovascular risk stratification using glycemic metrics, imaging modalities, and biomarkers are 
discussed, alongside evolving pharmacological strategies. In particular, sodium–glucose cotransporter-2 inhibitors 
and glucagon-like peptide-1 receptor agonists have demonstrated significant cardiovascular and renal benefits 
beyond glycemic control. Non-pharmacological interventions, including lifestyle modification and risk factor 
management, remain foundational to care. Despite progress, important knowledge gaps persist regarding disease 
mechanisms, optimal risk prediction, and individualized treatment strategies. Addressing these gaps is critical to 
reducing the cardiovascular burden of diabetes and improving long-term outcomes.