Speaker Abstract

Reducing the Risk of Cardiovascular Disease in People with Type 2 Diabetes

F. Xavier Pi-Sunyer, St. Luke's-Roosevelt Hospital Center, Columbia U., New York, N.Y. 10025.

Type 2 diabetes mellitus is associated with a two- to four-fold risk of coronary artery disease (CAD). Its prevention is important in terms of quality of life and economics. The risk factors which are particularly important include hyperglycemia, dyslipidemia (high triglycerides (TG), low LDL-cholesterol (LDL-C), low HDL-C, and small-dense LDL-C particles), obesity, and central fat distribution. In addition, hypertension is common. Insulin resistance and hyperinsulinemia have been implicated in some studies. Primary and secondary prevention require similar strategies: to reduce the above risk factors. Dietary advice will aim at lowering weight in the obese and at lowering glucose, LDL-C and TG on all. Increasing physical activity will also improve these parameters. If these are insufficient, pharmacological therapy is indicated. Glycemic control improves dyslipidemia, irrespective of what drug is used. The drugs of first choice for LDL-C reduction in diabetes are the statins. Bile and fibric acids should be used cautiously. Nicotinic acid leads to glucose deterioration. Few studies have been done using combinations of lipid-lowering drugs in diabetic patients. Hypertension should be controlled, with agents that do not increase insulin resistance.