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Prevention of macrovascular complications

M. Fisher*

Glasgow Royal Infirmary, Glasgow, Scotland

* Dr Miles Fisher, Consultant Physician, Glasgow Royal Infirmary, Castle Street, Glasgow G4 OSF, Scotland.

Abstract

The cardiovascular burden of diabetes is well established. Reduction in this burden requires a multifactorial approach, encompassing control of glycaemia, reduction in traditional cardiovascular risk factors (hypertension, hyperlipidaemia), use of antiplatelet agents and angiotensin-converting enzyme inhibitors, and aggressive treatment of coexisting cardiovascular disease. Metformin is the drug of first choice for blood glucose control in most patients, and the newer thiazolidinediones have some additional effects on other aspects of the metabolic syndrome that could provide extended cardiovascular benefit. Several different groups of drugs are of proven benefit in reducing blood pressure, and multiple agents may be required. Statins are of proven benefit for both primary and secondary prevention, but there is less hard evidence available on the use of fibrates in people with diabetes. Use of these multiple potential therapies is included in several guidelines for reducing cardiovascular risk in people with diabetes, but compliance and adherence is a problem.

Key Words: Blood glucose control • cardiovascular risk • diabetes mellitus • hyperlipidaemia • hypertension

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