Preventing cardiovascular disease in diabetes and glucose intolerance: evidence and implications for care

Cardiovascular mortality has increased in diabetic women and decreased less dramatically in diabetic men compared with sex-matched nondiabetic controls. Cardiovascular outcomes-including myocardial infarction, stroke, and peripheral vascular disease-are worse in patients with diabetes and decrease with attention to tobacco avoidance as well as improved control of blood pressure and lipids. Although chronic glucose control has generally not been shown to decrease macrovascular events, tight control of glucose during acute ischemia or illness appears to be beneficial. This article reviews the strategies for cardiovascular disease prevention that should be stressed in the comprehensive evaluation and management of patients with diabetes and glucose intolerance.