Reducing cardiovascular risk in type 2 diabetes mellitus

The last decade has seen a radical change in our assumptions about the best ways to lower cardiovascular risk in patients with type 2 diabetes mellitus. In the past, considerable emphasis was placed on reduction of plasma glucose as the key to lowering cardiovascular risk and there were misplaced perceptions of benefit from aspirin in all patients. There is now overwhelming evidence that lowering cholesterol with statin therapy and lowering blood pressure with antihypertensive agents, at least to a systolic value of 130 mmHg, are the keys to success in achieving such benefits. Indeed, recent reductions in cardiovascular mortality in diabetes have largely been driven by greater use of statins and antihypertensive agents. Trial and meta-analytical evidence has shown that aspirin therapy for primary prevention of vascular events is unwarranted, intensive glucose lowering actually achieves limited reductions in cardiovascular events, and fibrate therapy has no clear effect upon vascular events in type 2 diabetes despite favourable changes in lipid subfractions.