When does cardiovascular risk increase in the pathology of type 2 diabetes mellitus (DM)?

Updated: Sep 27, 2021
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Increased cardiovascular risk appears to begin prior to the development of frank hyperglycemia, presumably because of the effects of insulin resistance. Stern in 1996 [29] and Haffner and D'Agostino in 1999 [30] developed the "ticking clock" hypothesis of complications, asserting that the clock starts ticking for microvascular risk at the onset of hyperglycemia, while the clock starts ticking for macrovascular risk at some antecedent point, presumably with the onset of insulin resistance.

The question of when diabetes becomes a cardiovascular risk equivalent has not yet been settled. Debate has moved beyond automatically considering diabetes a cardiovascular risk equivalent. Perhaps it would be prudent to assume the equivalency with diabetes that is more than 5-10 years in duration.

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