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Cardiovascular Complications of Diabetes Mellitus: What We Know and What We Need To Know about Their Prevention

Peter J. Savage, MD
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From the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland. For the current author address, see end of text. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “Risks and Benefits of Intensive Management in Non-Insulin-dependent Diabetes Mellitus: The Fifth Regenstrief Conference.” To view a complete list of the articles included in this supplement, please view its Table of Contents. Requests for Reprints: Peter J. Savage, MD, Epidemiology and Biometry Program, DECA, Two Rockledge Center-Rm 8154, National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Bethesda, MD 20892-7934.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(1_Part_2):123-126. doi:10.7326/0003-4819-124-1_Part_2-199601011-00008
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Cardiovascular disease is a major cause of morbidity and mortality in patients with non–insulin-dependent diabetes mellitus (NIDDM). With an increase in the number of older diabetic persons, an increase in U.S. minority populations with high rates of diabetes, and the proven success of new methods to reduce microvascular complications, the importance of diabetic macrovascular complications will increase. The relative effectiveness of different treatments to reduce the incidence of diabetic cardiovascular complications is poorly understood. In addition to relative efficacy, issues related to patient burden and the economic cost of different treatments must be considered. Some of the information needed to improve therapy will be available soon from ongoing clinical trials. Obtaining definitive answers to other questions, especially those related to the relative benefit of intensive glucose level control compared with control of other known cardiovascular disease risk factors, will require additional studies. Although several questions unique to diabetic patients remain unanswered, results of previous clinical trials done among largely nondiabetic participants can be used to develop interim recommendations for cardiovascular disease prevention. Until definitive guidelines for prevention are established, combining aggressive therapy for known cardiovascular disease risk factors with efforts to normalize the glucose level offers the best chance to reduce the higher risk for cardiovascular disease associated with NIDDM.





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