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Reassessment of cardiovascular risk in diabetes

Jaffe, Jonathan R; Nag, Soma S; Landsman, Pamela B; Alexander, Charles M

doi: 10.1097/MOL.0b013e3280106208
Therapy and clinical trials

Purpose of review To review recent trials and reassess cardiovascular risk in people with diabetes.

Recent findings Recent clinical trials have tended to focus on lower-risk participants with diabetes who have had event rates considerably lower than participants in the early lipid trials. Statin studies have generally shown benefit in those without cardiovascular disease and at lower levels of low-density lipoprotein cholesterol. Results of fibrate and glitazone studies have been mixed; the question of benefit among statin-treated patients remains unanswered. Investigators failed to confirm the benefits of glucose control observed in the original Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction study possibly due to study design issues. Epidemiologic follow-up of the Diabetes Control and Complications Trial showed sustained benefit of glucose control. A number of studies have shown the benefit of inpatient control of blood glucose. We await the results of ongoing blood pressure trials and other ongoing trials, which should provide much new information. A conceptual model of cardiovascular risk for people with diabetes mellitus based on the UK Prospective Diabetes Study outcomes model is discussed.

Summary The majority of adults with diabetes have a substantially greater risk compared with those without diabetes and a small percentage has very high risk. A minority of individuals may have considerably lower 10-year risk.

Merck & Co., Inc., Sumneytown Pike, West Point, Pennsylvania, USA

Correspondence to Charles M. Alexander, MD, Outcomes Research, Merck & Co., Inc., Sumneytown Pike, PO Box 4, WP39-130, West Point, PA 19486, USA Tel: +1 215 652 8809; fax: +1 215 652 0860; e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.