Preventing cardiovascular events in patients with diabetes mellitus.

Diabetes mellitus and obesity are becoming increasingly prevalent in the United States. Patients with diabetes are 2 to 3 times more likely to develop cardiovascular disease (CVD) than are individuals without diabetes, but proper diabetes management and metabolic control can reduce this risk. Nonpharmacologic interventions, such as diet and exercise, can help to reduce weight and control insulin resistance, blood glucose levels, and lipid abnormalities, thereby lowering the risk of adverse cardiovascular outcomes. However, diet and exercise can provide particular challenges for the patient with diabetes. Antiobesity drugs, such as sibutramine and orlistat, can help individuals with diabetes lose weight and can have some effect on metabolic control. Alcohol use and hormone replacement therapy are still controversial topics with regard to reducing the risk of CVD. Smoking is known to be particularly dangerous for those with diabetes, and it is important for health care providers to help their patients stop smoking. Early and aggressive intervention in treating risk factors can reduce the risk of developing diabetes and prevent CVD in the patient with diabetes.