Camilla Cocchi, Valentina Selleri, Giada Zanini, Federica Moscucci, Susanna Sciomer, Sabina Gallina, Milena Nasi, Giovambattista Desideri, Marcello Pinti, Claudio Borghi, Anna Vittoria Mattioli
Background: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among women with type 2 diabetes (T2DM). The interplay between sex-specific biological factors, social determinants, and environmental exposures amplifies cardiometabolic risk across the female life course. Objectives: This manuscript explores how socioeconomic disparities, environmental pollution, chronic stress, food insecurity, and climate change synergistically increase the burden of T2DM and cardiovascular complications in women, and reviews potential preventive interventions including dietary strategies. Methods: A comprehensive narrative review was conducted, synthesizing current evidence on the exposome, social inequities, environmental insults, and evidence-based lifestyle interventions that contribute to or mitigate the development and progression of T2DM and CVD in women. Results: ), climate change-induced food insecurity, and heat-related stress further exacerbate insulin resistance, systemic inflammation, and vascular dysfunction. Life transitions such as gestational diabetes mellitus and menopause further magnify these risks. Current healthcare models insufficiently address these multilayered factors. Conclusion: Effective cardiovascular prevention in women with T2DM requires a life-course approach that integrates biological transitions with environmental and social determinants to deliver sex-sensitive, stage-specific strategies.