[What is the most effective approach to the reduction of cardiovascular risk in type-2 diabetes mellitus?].

It is well known that the target blood glucose values are not fulfilled in treatment of patients with type 2 diabetes mellitus. (UKPDS) The high mortality rate in type 2 diabetes mellitus is associated with the augmented cardiovascular risk. It is well documented, that the beneficial influence of high blood pressure, dyslipidaemia, and hypercoagulation compared to hyperglycaemia, is a more powerful approach in reduction of cardiovascular risk in type 2 diabetes mellitus. The effect of medical interventions on alteration of cardiovascular risk and glucose homeostasis is not always concordant: beta-blockers automatically reduce cardiovascular risk, but may result in deterioration of blood glucose values, sulfanylurea drugs effectively reduce hyperglycaemia, but could paradoxically increase the cardiovascular risk. The acarbose, metformin, thiazolidindione, fibric acid treatment improves the profile of vascular risk factors, additionally could have a beneficial metabolic effect resulting in reducing cardiovascular risk in patients with type 2 diabetes mellitus.

CONCLUSIONS

the cardiovascular risk in type 2 diabetes mellitus can be most effectively influenced by reduction of high blood pressure, dyslipidaemia, and dysfunction of haemostasis. The improvement of glucose homeostasis is, novel medical interventions seem to be important tools in reducing cardiovascular risk in patients with type 2 diabetes mellitus.