Overview of cardiovascular risk in older people with diabetes: basic pathophysiology, risk factors and management

Increasing age is a risk factor for diabetes; consequently, diabetes is prevalent in older people. Older people with diabetes are at high risk of cardiovascular disease (CVD) and cardiovascular events, such as myocardial infarction and heart failure. Multiple pathological processes underlie CVD, including inflammation, oxidative stress, endothelial dysfunction, thrombosis and angiogenesis. These pathological processes are influenced by age, ethnicity, genetic makeup, obesity, hyperglycaemia, insulin resistance, dyslipidaemia, hypertension, renal disease, inappropriate diet and inactivity, which are components of the metabolic syndrome and CVD risk factors. The more risk factors present, the higher the risk of CVD. Significantly, vascular damage occurs slowly; therefore, it is essential to undertake a comprehensive vascular risk assessment and manage the risk early in life to improve the individual’s outcomes. Management strategies must be negotiated with the individual and appropriately tailored to their CVD risk and functional status, life expectancy and safety.