Climate Change and Cardiovascular Complications of Diabetes

Climate change is emerging as a clinically relevant driver of cardiometabolic risk, particularly among individuals with diabetes. Increasing frequency and severity of extreme weather events, including heat waves, cold exposure, and air pollution, can disrupt physiological homeostasis and access to essential healthcare resources. People with diabetes are uniquely vulnerable due to impaired thermoregulation, increased risk of dehydration, and high prevalence of cardiovascular and kidney disease.

Temperature extremes impose significant cardiovascular stress. Heat exposure promotes dehydration, hemoconcentration, and increased cardiac workload, contributing to ischemia, arrhythmia, and heart failure. Cold exposure increases vascular resistance and blood pressure, further elevating cardiovascular risk. In parallel, air pollution and wildfire smoke amplify systemic inflammation, oxidative stress, and endothelial dysfunction, accelerating atherosclerosis and increasing the likelihood of acute cardiovascular events. Clinical risk is further modified by age, comorbidities, socioeconomic factors, and access to healthcare infrastructure. Clinically, these findings support anticipatory management strategies, including patient education on heat and cold exposure, proactive medication adjustment, and closer monitoring during periods of environmental stress. Effective mitigation requires a multilevel approach, including patient education, medication management, disaster preparedness, and climate-resilient health systems. Integrating environmental data into clinical care and the use of predictive tools may enable proactive risk reduction. Climate change should be recognized as an emerging cardiovascular risk multiplier in diabetes, requiring coordinated action across clinical care, public health, and policy.