Good news for the older patient with diabetes: added cardiovascular risk reduction

Both hypertension and diabetes carry an increased risk of cardiovascular and renal disease and are commonly associated conditions. The prevalence of hypertension in the diabetic population is particularly high, approximately 40% in middle-aged patients with type II diabetes mellitus and increases to approximately 60% by age 75. Hypertension increases an already high risk of cardiovascular disease events associated with diabetes mellitus and is also a risk factor for the development of microalbuminuria and retinopathy. Overall mortality from heart disease has declined substantially in the USA in the past 30 years. The extent of this mortality rate decline has been assessed from representative cohorts, the NHANES I survey (1971-1975) and the NHANES I epidemiologic follow-up survey (1982-1984). Both cohorts were followed prospectively for 8 to 9 years. Mortality rates for heart disease and ischemic heart disease in men and women with diabetes have not decreased to the extent that they have for nondiabetic patients. Although these decreases in men with diabetes were smaller than their nondiabetic counterparts, women with diabetes had increases for both total and ischemic heart disease. Three recent clinical trials have addressed the effects of aggressive intervention in diabetes, particularly older patients with type II diabetes mellitus.