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Managing cardiovascular risk in patients with diabetes
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  1. Lars Rydén
  1. Karolinska Hospital, Department of Cardiology, Thoracic Clinic 5 tr, S-171 76 Stockholm, Sweden
  1. Professor Rydén email: lars.ryden{at}ks.se

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The prevalence of diabetes is increasing dramatically. If the number of patients in the developed and developing worlds with diabetes is combined, there are currently 100 million. It is predicted that this will increase to 200–225 million within the next 25 years.1

There are a number of reasons for this dramatic increase. The aging of the general population is a significant factor. Also, lack of physical exercise combined with an unhealthy diet plays an important role. As developing countries continue to adopt the bad habits of the West, the incidence of diabetes will rise.

About 90% of diabetic patients will have type 2 diabetes, which develops with age and has a strong relation to macrovascular complications.

Patient outcome

It is interesting to observe the changing patterns of mortality and morbidity in diabetic and non-diabetic patients. For non-diabetic patients there has been a successive decrease in mortality caused by cardiovascular events.2 However, in the diabetic population this has not been the case. For male diabetic patients there has been no significant change. In female diabetic patients the outcome has worsened over the years.

One reason for the poor outcome for diabetic patients is probably the divided care they receive. They are generally cared for by endocrinologists, although the main manifestations of their disease are cardiovascular which are treated by cardiologists. It is therefore important for endocrinologists and cardiologists to meet to plan patients' treatment protocols.

The risk of cardiovascular disease in the diabetic population is high. For example, the MRFIT trial showed that increasing blood pressure or cholesterol concentrations increases the risk for cardiovascular events in both diabetic and non-diabetic patients.3 However, at each point the risk is much greater for diabetic patients.

Risk factors in diabetic patients

In non-insulin dependent diabetic patients the conventional risk factors for cardiovascular disease are common. For example, approximately …

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