Diabetic Cardiovascular Complications in Women and Young Adults

Cardiovascular disease (CVD) is the major complication and leading cause of death among individuals with type 2 diabetes (T2D). Women and younger adults with T2D face a disproportionately higher risk of CVD, compared with their male or older counterparts. This review summarizes clinical and epidemiological evidence on the mechanisms underlying these disparities and highlights directions for future research and clinical practice.

Women with T2D lose the cardioprotection typically seen in the general population and face disproportionately higher cardiovascular risk. This excess risk is influenced by adverse metabolic profiles preceding T2D onset; female-specific factors such as polycystic ovary syndrome and gestational complications; and non-biological contributors, including delayed diagnosis and less optimal healthcare utilization and delivery in women compared with men. Young adults with early-onset T2D also experience a heightened cardiovascular burden, driven by a more aggressive disease course, prolonged exposure to metabolic abnormalities, and distinctive psychosocial stressors that compound their risk. Despite these disparities, both female and young adult patients with T2D remain understudied, hindering the development of precision prevention and management strategies.

Future mechanistic and interventional research that integrates sex and age as key biological factors will be critical for advancing precision approaches and reducing disparities in diabetes care and outcomes.