Diabetes as a 'cardiovascular disease equivalent': implications for treatment.

Patients with type 2 diabetes are at high risk of cardiovascular disease. Schramm et al. have published a study in which all residents of Denmark aged 30 years or older on 1 January 1997 (approximately 3.3 million individuals) were followed up for 5 years by individual-level linkage of nationwide registers. The study indicated that patients requiring glucose-lowering therapy (oral treatment, insulin, or combined insulin and oral therapy) exhibited a cardiovascular risk comparable to that of nondiabetic individuals with a prior myocardial infarction, irrespective of sex and type of diabetes. In recent AHA and American Diabetes Association guidelines for the primary prevention of cardiovascular disease, all treatment recommendations for patients with type 2 diabetes also apply to those with type 1 diabetes and to both sexes. Epidemiological evidence reported by Schramm et al. is in line with these recommendations.