Cardiovascular disease: much more aggressive in patients with type 2 diabetes.

It is estimated that 80% of individuals with type 2 diabetes die of coronary heart disease. Several factors have been found to contribute to the accelerated atherosclerosis present in diabetic patients. These include hyperglycemia-induced endothelial cell dysfunction, impaired fibrinolysis, increased platelet aggregation, and dysfunctional arterial remodeling. The evidence supports that a healthy lifestyle, statin drugs, angiotensin-converting enzyme inhibitors, and aspirin can modify these factors and slow the atherosclerosis process observed in type 2 diabetes. Because of the high prevalence of cardiovascular disease in people with type 2 diabetes, early cardiac testing is indicated. The optimal strategy for coronary revascularization in diabetic patients remains controversial and is discussed in detail in this review.