Diabetes and cardiovascular disease

Abstract

Compelling evidence has been accumulating that hyperglycemia is independently related with excessive morbidity and mortality in cardiovascular disease (CVD) involving all components of the “gluco-triade”, i.e., HbA1c, fasting plasma glucose, and postprandial or postload plasma glucose. Today's policy for blood glucose-lowering therapy must be “reach and maintain glycemic goals safely and gently.” All available drug options provide a (placebo substracted) HbA1c decrease of around 1%. Due to the often much higher demand for lowering HbA1c, double combinations and even triple therapies are necessary. Avoiding side effects, especially hypoglycemia and too much weight gain, seems to be a priority of today's blood glucose-lowering therapy. The effectiveness of blood glucose-lowering therapy to reduce not only microvascular, but also cardiovascular complications of diabetes, has been demonstrated in the landmark studies DCCT for type 1 diabetes and UKPDS for (newly diagnosed) type 2 diabetes. The most striking long-term “legacy effects” of lowering blood glucose evolved in both studies during the open post-study observation period. The concept of differential therapy on the individual level for blood glucose-lowering therapy, which may be particularly complex in patients with coexisting CVD, will be further emphasized in the future.