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What is atherosclerotic cardiovascular disease (ASCVD)?

Atherosclerosis is the main cause of cardiovascular disease (CVD), and atherosclerotic cardiovascular disease (ASCVD) is particularly common in people living with type 2 diabetes1,2. Approximately nine out of ten people with type 2 diabetes and established cardiovascular disease have atherosclerotic cardiovascular disease, including heart attack and stroke3.

Your doctor or diabetes specialist nurse may already have discussed the connection between type 2 diabetes and heart disease with you and you may already be taking steps to reduce your risk. However, many people with type 2 diabetes are unaware that they have increased risk of developing cardiovascular disease4-7. If you have type 2 diabetes, you have about twice as much risk of having cardiovascular disease as people without diabetes8,9. In fact, one-third of people living with type 2 diabetes have established cardiovascular disease3.

Cardiovascular disease is a general term for a wide range of conditions affecting your heart or blood vessels and includes, but is not limited to, high blood pressure, heart failure, peripheral artery disease (PAD), angina (chest pain caused by reduced blood flow to the heart muscles), heart attacks and strokes10.

Atherosclerosis is the main cause of cardiovascular disease, and atherosclerotic cardiovascular disease (explained further below) is particularly common in people living with type 2 diabetes because excess blood sugar fuels the progression of atherosclerotic cardiovascular disease1,2. Approximately nine out of 10 people with type 2 diabetes and cardiovascular disease have atherosclerotic cardiovascular disease3.

What is atherosclerotic cardiovascular disease?

Atherosclerosis is the build-up of fats, cholesterol and other substances in your arteries and on your artery walls. This build up is called plaque11,12. The plaques cause your arteries to harden and narrow, restricting blood flow and oxygen supply to your organs. Potentially the plaques can also burst, leading to a blood clot. If the blood flow to your heart is blocked it can cause a heart attack and if a blood clot blocks an artery in your brain, this causes a stroke11,12

Below is an illustration of the build up of plaque in the arteries, leading to increased risk of cardiovascular events11,12.

Glucose levels comparison

Atherosclerosis can also cause problems in other parts of your body. Peripheral artery disease, for example, is caused when blood flow is restricted in the arteries in your legs11,12. Peripheral artery disease can cause pain in your calves, hips, buttocks and thighs – usually when you’re walking or exercising12.

Atherosclerosis develops over years and does not tend to have any symptoms at first13. Thus, many people may be unaware that they have it. Sometimes people only find out they have atherosclerotic cardiovascular disease when they have a stroke, transient ischaemic attack (TIA, or mini-stroke) or heart attack12,13.

Diabetes and Atherosclerotic Cardiovascular Disease

How atherosclerotic cardiovascular disease can lead to the formation of plaques

Doctors used to believe that high cholesterol was the driving force behind the formation of atherosclerotic plaques and that reducing cholesterol levels through lifestyle and medication was the key to managing the condition. However, we now know that high blood sugar is an important factor. High blood sugar results in inflammation1, causing damage to the arterial wall and causes plaques to form11,12,14. This supports why people with type 2 diabetes are 2–4 times more likely to have a heart attack or stroke than those without the condition15,16.

There are other factors that contribute to atherosclerotic cardiovascular disease risk such as overweight and obesity, smoking and high blood pressure17. Together with high blood sugar, these are all called ‘modifiable’ risk factors because it is possible to reduce the impact of these factors with lifestyle changes and medications.

How to reduce the risk of atherosclerotic cardiovascular disease

The good news is that there are many ways to reduce the risks of atherosclerotic cardiovascular disease events and many of these will not only improve your general health but also help prevent consequences of your diabetes too. Here are some lifestyle changes that you can make10.

You can read more about lifestyle changes promoting cardiovascular health in this blog post.

Evidence suggests that addressing multiple cardiovascular risk factors at once can have the greatest benefit, so the more you can do, the better11.


  1. Beckman JA, Creager MA and Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA. 2002;287:2570–81.
  2. Barquera S, Pedroza-Tobías A, Medina C, et al. Global overview of the epidemiology of atherosclerotic cardiovascular disease. Archives of medical research. 2015;46:328-338.
  3. Mosenzon O, Alguwaihes A, Leon JLA, et al. CAPTURE: a multinational, cross-sectional study of cardiovascular disease prevalence in adults with type 2 diabetes across 13 countries. Cardiovasc Diabetol. 2021;20:154.
  4. International Diabetes Federation. Taking Diabetes to Heart Survey [online] last updated November 2020. Available from: www.idf.org/takingdiabetes2heart. Last accessed: March 2022.
  5. Merz C, Buse J, Tuncer D, et al. Physician attitudes and practices and patient awareness of the cardiovascular complications of diabetes. Journal of the American College of Cardiology. 2002;40:1877-1881.
  6. American Heart Association and American Diabetes Association. Know Diabetes By Heart™ [online]. Available from: https://www.knowdiabetesbyheart.org/. Last accessed: March 2022.
  7. American Heart Association and American Diabetes Association. People with T2D Baseline Survey, Online survey 2018. Available From: https://www.knowdiabetesbyheart.org/about-the-initiative/. Last Accessed: March 2022.
  8. Sarwar N, Gao P, Seshasai SR, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375:2215-22.
  9. Rao Kondapally Seshasai S, Kaptoge S, Thompson A, et al. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. 2011;364:829-841.
  10. World Health Organization. Cardiovascular diseases. Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds). Last accessed: March 2022.
  11. Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2021;52:e364-e467.

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