Reducing the cardiovascular consequences of diabetes mellitus

Type 2 diabetes is an important, independent risk factor for cardiovascular disease. As a result of the pandemic explosion of Type 2 diabetes, reducin g the human and financial consequences of the disease is a major healthcare concern. In primary prevention, antihypertensive treatment, aspirin and li pid-lowering intervention are effective at reducing the incidence of corona ry heart disease although the beneficial effect of optimal glycaemic contro l remains to be conclusively proven. Type 2 diabetic patients with acute my ocardial infarction should receive a specific programme of intensive treatm ent, which includes optimal glycaemic control using intensive insulin treat ment, thrombolysis, and early use of beta-blockers and angiotensin-converti ng enzyme inhibitors. Secondary prevention is also essential because beta-b lockers and lipid interventions are more effective in Type 2 diabetic patie nts than in non-diabetic patients with coronary artery disease. Unfortunate ly, too many Type 2 diabetic patients do not receive adequate treatment or do not comply with their long-term medical recommendations. (C) 1998 John W iley & Sons, Ltd.