Abstract
Vascular complications are among the most common chronic complications of type 2 diabetes mellitus and the major cause of morbidity and mortality in these patients. The risk of coronary events is increased threefold in male diabetics and even fivefold in female diabetics in comparison with non-diabetics.
In order to reduce a (very) high cardiovascular risk in diabetic patients, a combination of lifestyle measures and medication therapy is used. Lifestyle measures favourably affect hyperglycaemic control as well as other risk factors associated with insulin resistance.
Pharmacological treatment to prevent macrovascular changes involves renin-angiotensin-aldosterone system blockade (ACE inhibitor or AT1 blocker), management of dyslipidaemia with a statin, and administration of metformin provided there are no contraindications. Reducing a persistent residual risk in a diabetic patient is possible with a combination with other strategies (combination therapy for hypertension, addition of fenofibrate to the treatment of microvascular complications, choice of additional antihyperglycaemic strategies - pioglitazone, possible incretin-based therapy of diabetes, or properly managed insulin therapy).
An actual delay or prevention of vascular complications of diabetes can be achieved by means of a comprehensive and intensive intervention made, if possible, as early as prediabetic stages.