Cardiovascular disease is the leading cause of morbidity and mortality among people with diabetes worldwide, accounting for 60% of all deaths in diabetics. Despite advances in our pathophysiologic understanding of diabetic co-morbidities and measures to help counter these, diabetics still remain at increased risk for cardiovascular disease complicating our overall approach to management. Diabetics, in particularly type 2, are often fraught with additional risk factors contributing to their overall propensity for developing cardiovascular disease. These include, but are not limited to, obesity, dyslipidemia, poor glycemic control, lack of physical activity, and hypertension. In response to this, research driven guidelines focusing on primary prevention have continued to arise with new clinical targets and goals substantially changing our approach with the diabetic population. It is important to note early on, type 1 diabetics carry a higher risk of cardiovascular disease for which the pathophysiology is only recently being elucidated. The underlying relationship between cardiovascular events and risk factors is, however, not well understood. For this reason, management approaches to risk reduction have been extrapolated from experience in type 2 diabetes mellitus. The purpose of this chapter is to present the conclusions of current literature pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the new guidelines, and clinical targets, including preventative measures for subclinical cardiovascular disease for the contemporary management of patients with diabetes mellitus.
Part of the book: Coronary Artery Disease