Type 2 diabetes affects the health of more than 1.5 million Australians.

Lifetime risk of developing the condition is at least one in three, and it is now the fourth most common condition managed in general practice.

Much attention has been given to the prevalence, prevention and management of the microvascular complications of type 2 diabetes (nephropathy, neuropathy, and retinopathy). The focus of this report is instead on diabetes as it relates to cardiovascular disease (CVD) – the dark heart of diabetes.

CVD is the most important complication of type 2 diabetes, accounting for not only the majority of its financial costs, but also a large proportion of the reduced health and reduced life expectancy in those with the condition.

Diabetes is also well recognised as an independent risk factor for all forms of CVD. The majority of patients (almost two in three) report concomitant CVD, and CVD remains the leading cause of death in people with type 2 diabetes.

Despite many years of improvements in therapies that lower blood glucose or address other CVD risk factors, and falling rates of cardiovascular deaths overall, diabetes continues to approximately double the risk of developing or dying from CVD. The risk is even more pronounced in women (type 2 diabetes erodes the gender associated protection against CVD), those with early-onset diabetes (before 40 years of age), and Indigenous Australians.

People with type 2 diabetes are unusually prone to dying from heart failure or sudden cardiac death. The likelihood of death from heart failure is elevated to the same level as from myocardial infarction, and sudden cardiac death is twice as common in those with type 2 diabetes as in those without the condition.

However, death from CVD is not inevitable in people with type 2 diabetes. This report outlines the multifactorial interventions that can significantly reduce cardiovascular risk and improve survival in those with established CVD.