Trials of cardiovascular risk factor management in type 2 diabetes.

PURPOSE OF REVIEW: To provide an overview of recent clinical trial findings relevant to cardiovascular risk management in patients with diabetes.

RECENT FINDINGS: Recent trial evidence has demonstrated benefits of routine blood pressure (BP) lowering, regardless of initial BP levels, in people with type 2 diabetes. In addition, new data indicate that any BP-lowering strategy in diabetic patients needs to be continued to realise sustained benefits. The effects of blood glucose lowering have been addressed in a number of recently concluded clinical trials; together, these have failed to provide clear evidence of cardioprotection with intensive glucose control over a 4-5-year period. Long-term data, however, suggest that such benefits may only appear later. A recent meta-analysis of statin trials has confirmed the benefits of these agents in patients with diabetes. Two new trials of aspirin for 'primary prevention' of cardiovascular events in diabetic patients have failed to show benefit; however, both were underpowered.

SUMMARY: Recent clinical trial data have cemented the crucial role of BP-lowering and statin treatment for the prevention of cardiovascular events in patients with diabetes, but the uncertainty about intensive glucose control for these outcomes remains. New evidence relating to other lipid-modifying agents and routine antiplatelet therapy in diabetes is anticipated over the next few years.