[Metabolic control or reduction of vascular risk with current treatments. What is the priority?]

In patients with type 2 diabetes, tight glycemic control prevents or delays the develop-ment of microvascular complications. In contrast, there is continued debate on the effect of macrovascular complications and the role of early glycaemic control on the ensuing cardiovascular disease. Although large randomised clinical trials have not shown a clearly beneficial effect of intensive control in the short term, subsequent follow-up studies of participants in these trials suggest a favourable cardiovascular effect in the long term. Due to doubts about the increased risk of myocardial infarction with rosiglitazone, for the last few years regulatory agencies have required sponsors to demonstrate the cardiovascular safety of new drugs before they can be approved for the treatment of hyperglycae-mia. The cardiovascular safety trials published to date have shown that the new drugs do not increase cardiovascular risk and that some molecules may even provide some cardiovascular protection. These findings raise the following question: what is the priority when selecting lipid-low-ering drugs - metabolic control or reduced cardiovascular risk? The answer lies in the word individualisation. Treatment cannot focus solely on cardiovascular safety, without considering microvascular complications, which cause high morbidity and mortality. Patients with recent onset diabetes and long life expectancy will benefit from tight meta-bolic control. Patients with diabetes and established cardiovascular disease or at high risk are candidates for treatment that includes drugs with a demonstrated benefit in this pa-tient group.