Increased cardiovascular morbidity and mortality in diabetes mellitus: identification of the high risk patient.

Cardiovascular diseases are the major cause of morbidity and mortality in the diabetic patient. Acute myocardial infarction carries twice the mortality of that in the general population. Although in the thrombolytic era, in-hospital survival for both diabetic and non-diabetic patients have improved considerably, the overall case fatality rate due to out-of-hospital death is still more than 50%. Screening relates particularly to the systematic search for cardiovascular risk factors and asymptomatic atherosclerosis. The individual risk cannot exactly be described by the level of risk factors alone. Today, diagnosis of preclinical cardiovascular disease can identify the high risk patient for severe cardiovascular events. The presence of asymptomatic or 'preclinical' cardiovascular disease such as left ventricular hypertrophy, peripheral arterial vessel disease, carotid atherosclerosis, autonomic neuropathy, and renal dysfunction carries a markedly increased risk for symptomatic morbidity as well as cardiovascular mortality. The unfavorable connection between autonomic neuropathy and coronary heart disease risk has just recently been reported. Therefore, diabetic patients with existing cardiovascular disease should be investigated and managed as vigorously as is warranted by existing evidence.