Glycaemic control and cardiovascular disease: is there a light at the end of the tunnel?

Patients with type 2 diabetes mellitus (T2DM) have been shown by numerous studies to have a substantially increased risk of cardiovascular disease (CVD), including coronary artery disease, ischemic stroke and heart failure, even after adjusting for other known risk factors.1,2 First reported in the Framingham studies and followed by additional data including a meta-analysis of 102 prospective studies, diabetes confers about a two-fold excess risk for coronary heart disease and ischemic stroke in both men and women, and about a 2-fold and 5-fold excess risk of heart failure in diabetic men and women.1-3 However, there is still a debate as to whether improved glycaemic control reduces the excessive CVD risk of T2DM patients. Large randomised controlled trials (RCTs), aimed at determining the effect of anti-hyperglycaemic agents on CVD, provide a handful of important data, albeit not consistent answers. Nevertheless, looking further into these RCTs provides new perspective on the complex interplay between diabetes treatment and CVD.
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