Traditionally, the management of both type 1 and type 2 diabetes has been focused on glycaemic control. However, particularly in type 2 diabetes, these patients are at very much increased cardiovascular risk, which is illustrated by the observation by Haffner et al. (1998) that someone with type 2 diabetes has a similar risk of having a myocardial infarction as someone without diabetes who has already had a myocardial infarction. Life expectancy of someone with type 2 diabetes, if diagnosed between 40 and 60 years of age, is reduced by about 5–10 years. Mortality rate is increased more than twofold; fatal coronary heart disease is increased two- to fourfold; fatal stroke is increased two- to threefold; coronary heart disease is increased two- to threefold; cerebrovascular disease is increased more than twofold; peripheral vascular disease is increased two- to threefold; and cardiac failure is increased two- to fivefold (Krentz and Bailey, 2001).
These greatly increased risks in type 2 diabetes result from the clustering of risk factors seen in patients with this condition, particularly hypertension and dyslipidaemia. The UK Prospective Diabetes Study (UKPDS) Group (1998) showed that improved blood glucose had relatively little impact on the incidence of cardiovascular complications, but reducing blood pressure reduced risk significantly for these complications.
The Steno-2 study (Gaede et al., 2003) demonstrated that a multifactorial approach to target all major risk factors resulted in a much greater reduction in cardiovascular endpoints.