Biological surrogates for enhancing cardiovascular risk prediction in type 2 diabetes mellitus

The identification of individuals at increased risk for cardiovascular disease (CVD) events is the critical first step toward reducing CVD morbidity and mortality. Accurate models for cardiac risk stratification benefit high-risk patients, who stand to gain the most from aggressive treatments, including pharmacologic therapies for blood pressure control, lipid lowering, glycemic control, and smoking cessation, as well as lower risk patients, who may avoid the added expense and complications from unnecessary medications and procedures. The further stratification of CVD risk in patients with diabetes mellitus may be important in individualizing therapy and in developing future clinical trials to examine new approaches for CVD event reduction in patients with diabetes. This review examines the utility of various surrogate markers of CVD specifically in patients with diabetes by looking first at markers already recommended by both American Diabetes Association (ADA) and American Heart Association (AHA) treatment guidelines, followed by the most recent data on selected markers not routinely used.