Drugs for cardiovascular risk reduction in the diabetic patient.

The diabetic patient is at increased risk for cardiac events. Lowering hemoglobin A1c levels even within the normal range is associated with less cardiac risk. Oral agents for diabetes that reduce insulin resistance and its associated cardiac risk factors in addition to lowering glucose should be used. Energetic reduction of blood pressure with an emphasis on the use of angiotensin-converting enzyme inhibitors and beta blockers will further reduce cardiac risk. Reduction of low-density lipoprotein and triglyceride levels and elevation of high-density lipoprotein levels through judicious use of statins and other anti-lipid agents is essential and will lower the rate of cardiac events in the diabetic patients even more than in the nondiabetic patients. In addition, aspirin and folic acid supplementation should be utilized. Use of a multiple risk factor management strategy with these drugs will lower morbidity and mortality, improve quality of life, and save cost for the diabetic patient.