Minimizing Cardiovascular Morbidity and Mortality in Patients with Type 2 Diabetes Mellitus: A Literature Review

摘要

Most patients with type 2 diabetes mellitus will die from cardiovascular disease (CVD). Diabetic patients experience accelerated development of CVD and lower survival rates after CVD events. The following critical review presents pivotal trials shaping an evidence-based therapeutic approach for minimizing CVD risk. A literature search was conducted using diabetes, specific CVDs (hypertension, dyslipidemia, etc), and drug names as search terms. Articles were identified through Medline (1966 through November 2004), Current Contents, and bibliographies of the obtained articles. Clinical trial evidence should guide selection of drugs toward those that reduce CVD. In the absence of convincing evidence, therapeutic interventions should target CVD pathophysiology, CVD risk factors, and CVD, if present. Tight glycemic control has not proven to reduce CVD; however, tight control with metformin in overweight patients and insulin post myocardial infarction are linked with reduced CVD events. Statins are first line for low density lipopro-tein cholesterol (LDL-C) reduction therapy with an optimal target of less than 70 mg/dL, in patients who have established CVD and a minimum target of less than 100mg/dL in patients without established CVD. Alternatively, gemfibrozil reduces events in persons with near normal LDL-C but low (less than 40 mg/dL) high density lipoprotein cholesterol. Aspirin (greater than 100mg/day) should be considered for all diabetic patients with CVD risk factors or who are over 40 years of age. For patients with hypertension, a goal blood pressure of less than 130/80 mm Hg should be achieved using an angiotensin converting enzyme inhibitor or diuretic first line (unless they are contraindicated or other co-morbidities require alternate therapies). Overall, complex therapeutic regimens are necessary to fully minimize the risk of CVD.