Cardiovascular risk management in type 2 diabetes: From clinical trials to clinical practice

With diabetes in the United States reaching alarming proportions, reduction of cardiovascular (CV) risk has become a unique challenge to health care providers. Recent studies suggest that the magnitude of the atherosclerotic burden in diabetic patients is much greater than previously appreciated. Modern diagnostic techniques indicate that most patients with type 2 diabetes mellitus (T2DM) have clinical or "subclinical" macrovascular disease. Cardiovascular disease (CVD) continues to be the leading cause of morbidity and mortality among patients with T2DM, despite the availability of newer and more effective CV interventions. These facts highlight the need for more aggressive prevention strategies. There is growing consensus that given these patients' high risk for CV, all in, terventions in those with T2DM should be considered secondary prevention, even in diabetic subjects apparently free of CVD. This review focuses on recent randomized, clinical trials on the effect of controlling hyperglycemia, dyslipidemia, and hypertension in patients with T2DM. Taken together, they indicate that even modest improvements of risk factors have a great impact on CVD, in particular, treatment of lipids and blood pressure. The time has come for clinicians to adopt an aggressive strategy of risk factor reduction in subjects with T2DM.