Cardiovascular diseases (CVDs) are the leading causes of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). Secular changes in CVD outcomes have occurred over the past few decades, mainly due to a decline in the incidence of ischaemic heart disease. The onset of T2DM at a young age (<40 years), leading to a greater number of life-years lost, has also become increasingly common. Researchers are now looking beyond established risk factors in patients with T2DM towards the role of ectopic fat and, potentially, haemodynamic abnormalities in mediating important outcomes (such as heart failure). T2DM confers a wide spectrum of risk and is not necessarily a CVD risk equivalent, indicating the importance of risk assessment strategies (such as global risk scoring, consideration of risk-enhancing factors and assessment of subclinical atherosclerosis) to inform treatment. Data from epidemiological studies and clinical trials demonstrate that successful control of multiple risk factors can reduce the risk of CVD events by ≥50%; however, only ≤20% of patients achieve targets for risk factor reduction (plasma lipid levels, blood pressure, glycaemic control, body weight and non-smoking status). Improvements in composite risk factor control with lifestyle management (including a greater emphasis on weight loss interventions) and evidence-based generic and novel pharmacological therapies are therefore needed when the risk of CVD is high.

心血管疾病 (CVD) 是 2 型糖尿病 (T2DM) 患者发病和死亡的主要原因。过去几十年来，心血管疾病结局发生了长期变化，主要是由于缺血性心脏病发病率下降。T2DM 在年轻时（<40 岁）发病，导致更多生命年损失，也变得越来越常见。研究人员现在正在超越 T2DM 患者既定的危险因素，关注异位脂肪以及潜在的血流动力学异常在介导重要结局（如心力衰竭）中的作用。T2DM 具有广泛的风险，不一定与 CVD 风险相当，这表明风险评估策略（例如总体风险评分、考虑风险增强因素和评估亚临床动脉粥样硬化）对于指导治疗的重要性。流行病学研究和临床试验数据表明，成功控制多种危险因素可将CVD事件风险降低≥50%；然而，只有≤20%的患者达到了降低危险因素的目标（血脂水平、血压、血糖控制、体重和非吸烟状况）。因此，当 CVD 风险较高时，需要通过生活方式管理（包括更加重视减肥干预措施）和基于证据的仿制药和新型药物疗法来改善综合危险因素控制。