Abstract
Patients with diabetes type 2 are not directly endangered by dysglycemia but they suffer vascular complications. The diabetic patient with existing cardiovascular disease has a particularly high risk for further cardiovascular complications and therefore requires specific attention. This is not only due to the hyperglycemia, but due to the coexistence of further cardiovascular risk factors, such as hypertension, dyslidemia, visceral fat accumulation, chronic inflammation and coagulopathy, also clinically described as the metabolic syndrome. These patients need an intense and multi-modal therapeutic approach, not only for improvement of glycemic control. Also other vascular risk factors should be handled aggressively, such as blood pressure, coagulopathy and dyslipidemia. Recent studies--as STENO 2--indicate that a multi-modal and aggressive approach in diabetic patients can markedly improve their prognosis. Therefore, the current practice of a glucocentric approach should be changed towards a more vascular approach.
References
Dec 28, 1989·The New England Journal of Medicine
Jun 23, 1998·Lancet·L HanssonS Westerling
Jul 23, 1998·The New England Journal of Medicine·S M HaffnerM Laakso
Sep 11, 1998·BMJ : British Medical Journal
Jan 20, 1999·Circulation·W KoenigM B Pepys
Mar 4, 1999·The New England Journal of Medicine·J TuomilehtoR Fagard
Sep 14, 1999·The American Journal of Medicine·A M Gotto
Feb 17, 2000·Arteriosclerosis, Thrombosis, and Vascular Biology·M PyöräläK Pyörälä
Mar 7, 2000·Circulation·S M HaffnerM P Stern
Apr 19, 2000·Circulation·B M BalletshoferH U Häring
Aug 11, 2000·BMJ : British Medical Journal·I M StrattonR R Holman
Nov 28, 2001·Circulation·T HeitzerT Münzel
Jun 28, 2002·Diabetes Care·Frank B HuJoAnn E Manson
Jun 28, 2002·Diabetes Care·Anthony J G HanleySteven M Haffner
Jul 11, 2002·Diabetologia·S MüllerH Kolb
Jan 31, 2003·The New England Journal of Medicine·Peter GaedeOluf Pedersen
Jun 18, 2003·Journal of Diabetes and Its Complications·Antonella CaselliAristidis Veves
Jun 20, 2003·Lancet·Rory CollinsUNKNOWN Heart Protection Study Collaborative Group
Jul 23, 2003·Circulation·Subodh VermaDonald A G Mickle
Mar 16, 2004·Lancet·Rory CollinsUNKNOWN Heart Protection Study Collaborative Group
Aug 25, 2004·Lancet·Helen M ColhounUNKNOWN CARDS investigators
Nov 4, 2004·European Heart Journal·Małgorzata BartnikUNKNOWN Euro Heart Survey Investigators
May 14, 2005·Circulation Research·Anders H Berg, Philipp E Scherer
Oct 11, 2005·Lancet·John A DormandyUNKNOWN PROactive Investigators
Nov 24, 2005·Diabetes & Vascular Disease Research : Official Journal of the International Society of Diabetes and Vascular Disease·Daniel Walcher, Nikolaus Marx