Is diabetes still a state of premature cardiovascular death?

Abstract The association between diabetes and cardiovascular disease is now well accepted. For the Arnold Bloom lecture 2016 I described the great improvements in the management of cardiovascular disease that have occurred in the last 20 years in people with diabetes. Meta‐analysis has shown reductions in microvascular and macrovascular complications with control of blood pressure, but there is still some uncertainty as to how low the target systolic blood pressure should be. Meta‐analysis has also demonstrated that reductions in cholesterol decrease macrovascular complications, and larger doses of statins should be used in people with established atherosclerotic disease. The initial results of intensive glycaemic control trials in diabetes did not demonstrate reductions in macrovascular outcomes during the study period, but long‐term epidemiological follow up has shown long‐lasting benefits. Follow up of DCCT and UKPDS has shown reductions in cardiovascular events and total mortality, and shorter follow up of VADT and ADVANCE has shown reductions in a composite of cardiovascular outcomes and end‐stage renal disease respectively. Metformin, pioglitazone, empagliflozin and liraglutide have demonstrated specific effects, although use of pioglitazone is falling because of side effects. Future reductions in cardiovascular events in people with diabetes can be anticipated if these beneficial antidiabetes drugs can be used more widely in appropriate patients. Copyright ©...
Source: Practical Diabetes - Category: Endocrinology Authors: Tags: State of the art lecture Source Type: research