Stratifying risk in diabetes

A 56-YEAR-OLD man presents with a background history of type 2 diabetes. He is currently managed with lifestyle interventions and medication.

He reports that he is fairly well but not fit and experiences exertional dyspnoea now when walking up stairs and hills. This may have worsened over the last 12 months.

There has been no chest discomfort. He has a background history of hypertension and mild hyperlipidaemia. He has not smoked. He is quite sedentary and is under some stress with a heavy travel schedule as a banking analyst. There is a soft family history of cardiovascular disease.

Physical examination reveals