Abstract
It has been recognized for several decades that diabetic patients have a 2 to 3 fold increased risk for cardiovascular disease (CVD) compared with their nondiabetic counterparts.
29,62
This excess risk is evident in both type 1 and type 2 diabetes, affects women to a greater degree relatively than men, and is influenced by the background risk of the ethnic group for CVD. More than 50% of diabetic patients have evidence of CVD at diagnosis, and CVD is responsible for 75% to 80% of hospital admissions as well as deaths in diabetes.
62
The rate of first myocardial infarction in diabetic patients is similar to the rate of recurrent infarcts in nondiabetic patients,
21
and the prehospitalization fatality rate from myocardial infarction is significantly higher in diabetic patients than it is in nondiabetic subjects,
37
reducing the opportunities for treatment once an acute event supervenes. For these reasons, there is an increasingly recognized need to understand the basis for this increased risk and to seek ways to prevent and ameliorate CVD, the major cause of morbidity and mortality in diabetic patients. This article focuses on the major risk factors that have been identified as contributing to excess CVD, predominantly in type 2 diabetes, and discusses approaches to their modification from the standpoint of what has been demonstrated in clinical trials to be effective in the amelioration of CVD.
