Best practices for lowering the risk of cardiovascular disease in diabetes

Cardiovascular disease (CVD) is a common complication of diabetes; nearly 80% of all people with diabetes will die from macrovascular complications. Dyslipidemia, hypertension, hypercoagulability, poor glycemic control, smoking, obesity, and lack of physical activity are just some of the multiple risk factors responsible for the increased risk of CVD in diabetes. A multi-pronged approach to address these risk factors is imperative. Although nonpharmacological therapy is the cornerstone of treatment, some pharmacological treatments are almost always warranted. These may include statins for dyslipidemia and their pleiotropic effects, tight blood pressure control (especially with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers), antiplatelet therapy, and appropriately tight glycemic control based on comorbidities. Evidence has shown that this approach can reduce the risk of CVD in diabetes but that these strategies continue to be underutilized.