Cardiovascular outcomes in type 2 diabetes: the impact of preventative therapies.

The world is facing an unprecedented increase in type 2 diabetes. Most disability and premature mortality experienced by people with diabetes is related to cardiovascular disease. This review summarizes recent evidence about approaches for managing cardiovascular risk in patients with type 2 diabetes. While optimal blood pressure targets in people with diabetes remain uncertain, new data have demonstrated the benefits of routine blood pressure lowering in these patients, when administered without regard to initial blood pressure level. Other recent data indicate that blood pressure lowering treatment in patients with diabetes needs to be continued for ongoing benefit. The effects of intensive blood glucose lowering have been evaluated recently in a number of large trials, and individually these have failed to provide evidence of cardioprotection over a 4-5 year period. However, longer-term follow-up data suggest that there may be a delay in any such benefits becoming apparent. The benefits of statin therapy in preventing cardiovascular events in diabetic patients have been recently confirmed in a systematic overview of relevant trials; however, effects of fibrate therapy appear more limited. The role of antiplatelet agents remains unknown, as adequately powered trials of aspirin for the primary prevention of cardiovascular events in patients with diabetes have not yet been completed.