Management of cardiovascular risk in diabetic patients: evolution or revolution?

Diabetes is associated with a marked increase in the risk of cardiovascular disease. Epidemiological evidence shows that hyperglycemia, hypertension and disorders of both lipid and thrombosis are involved in the etiology of cardiovascular disease in diabetes. Intervention trials on each of such factors have demonstrated a favourable effect in terms of reduction of cardiovascular disease, suggesting that even in diabetic patients in whom blood glucose levels are adequately controlled, other cardiovascular risk factors, such as hyperlipidemia, hypertension and prothrombotic state, should be aggressively treated. The need for an aggressive treatment has been recently underscored by the UKPDS (United Kingdom Prospective Diabetes Study) researchers who suggest that polypharmacy is now needed for the prevention of diabetic complications, implying that this approach requires an adequate control of all cardiovascular risk factors even using associations of drugs for each of them. A thorough application of these concepts might appear difficult in particular when the resource cost is considered. However, it has been shown that blood glucose, blood pressure and serum lipid control are advantageous in diabetic patients not only in terms of cost/benefit ratio but also in terms of quality of life. In the present article, we will briefly review this evidence and discuss the ethical and socioeconomic concerns that may subsequently rise.