Report: Most Adults Fail to Recognize Diabetes as Cardiovascular Risk Factor

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Among adults in middle- to high-income nations, awareness of diabetes as a cardiovascular risk factor remains a persistent issue.

A new report suggests most adults from middle- and high-income countries failed to identify diabetes as a major risk factor for cardiovascular disease, underlining the need for a greater emphasis on patient awareness and education.

An analysis of an online survey from the American Heart Association (AHA), data from the report indicates 2 out of 3 adults from middle- and high-income countries across the globe did not recognize diabetes as a major risk factor for cardiovascular disease, including more than 50% of US adults included in the survey.

“These findings are alarming in the context of the substantial projected increase in diabetes over the coming 25 years, given that recognizing the connection between diabetes and [cardiovascular disease] may be crucial to individual and systemic investments in primary prevention,” wrote investigators.1 “Our findings therefore underscore the need for concerted efforts to increase public awareness of this common major [cardiovascular disease] risk factor.”

Despite successful efforts to mitigate the public health impact of cardiovascular disease, it remains the leading cause of death in the US according to the AHA’s Heart Disease and Stroke Statistics—2023 Update. With a well-documented association with increased risk of adverse cardiovascular outcomes and more than 150 million US adults living with diabetes or prediabetes, a lack of awareness surrounding the impact of diabetes as a risk factor stands to have a significant impact on public health in the coming decades.1,2

With this in mind, the current study was led by Dhruv Kazi, MD, the section head of Health Economics and the Associate Director of the Smith Center at the Beth Israel Deaconess Medical Center, along with a team of colleagues representing the AHA, the Ohio State University Werner Medical Center, and the University of North Carolina to explore the Awareness of diabetes as a major risk factor for cardiovascular disease using data from an online quality improvement survey from the AHA. Administered through the YouGov omnibus platform, the survey was delivered to participants in 50 countries in 2021 and provided investigators with data from more than 48,988 individuals in the current analysis.1

The primary intent of the analysis was to explore the proportion of individuals in each country who recognized diabetes as a cardiovascular risk factor, but investigators noted additional plans to evaluate variation in trends according to sex, age, geographic region, and country-level economic development.1

Results indicated 32.1% of respondents were able to correctly identify diabetes as a major risk factor for cardiovascular disease. Investigators pointed out similar awareness was observed among men and women (32.3% vs 31.9%; P=.34) but increased with age as respondents older than 65 years had a greater level of awareness than those aged 18-24 years (36.1% vs 30.0%; P <.001 for trend).1

When assessing geographic trends, investigators found awareness varied by country, with just 7.4% identifying diabetes as a risk factor in Slovenia compared to 47.3% in Lithuania. Further analysis suggested the greatest level of awareness among WHO geographic regions was observed in the Americas (36.5%; P <.001) and high-income countries exhibiting greater levels of awareness than lower-middle-income and upper-middle-income countries (P <.001).1

“The knowledge gap identified in our study has important public health consequences,” investigators added.1 “Individuals who do not recognize the cardiovascular risk associated with diabetes may be less likely to make the lifestyle changes necessary to prevent diabetes, get screened and treated once they develop diabetes, or adhere to strategies for [cardiovascular disease] prevention.”


  1. Chaudhary RS, Turner MB, Mehta LS, Al-Roub NM, Smith SC Jr, Kazi DS. Low Awareness of Diabetes as a Major Risk Factor for Cardiovascular Disease in Middle- and High-Income Countries. Diabetes Care. Published online December 13, 2023. doi:10.2337/dc23-1731
  2. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association [published correction appears in Circulation. 2023 Feb 21;147(8):e622] [published correction appears in Circulation. 2023 Jul 25;148(4):e4]. Circulation. 2023;147(8):e93-e621. doi:10.1161/CIR.0000000000001123