Reducing cardiovascular disease in patients with diabetes mellitus

Purpose of review Patients with diabetes may be considered high-risk for management of cardiovascular risk factors not only because of increased rates of myocardial infarction but also because of a high prevalence of significant subclinical coronary artery disease and a poorer prognosis after myocardial infarction. Recent findings Appropriate management of hypertension and hyperlipidemia has been shown unequivocally to reduce cardiovascular events. Benefit has been demonstrated with multiple antihypertensive agents; however, some studies suggest an advantage for angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Most data for management of lipid disorders in diabetes have. been obtained using statins; the value of combination lipid-lowering therapy remains to be validated. Summary The role of glucose control in managing cardiovascular risk in patients with diabetes remains unclear. Epidemiologic studies suggest a strong relation between markers of glycemia and cardiovascular risk, even extending into the nondiabetic spectrum, Ongoing trials are evaluating novel strategies for reducing cardiovascular events in patients with diabetes.