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Diagnosis of diabetes mellitus as a cardiovascular risk equivalent or risk factor and implications in drug therapy management

Brian K Irons

Current diabetes guidelines list the disorder as a cardiovascular risk equivalent or risk factor. Goals of therapy for hypertension or lipids or suggested use of aspirin are common though vary and there are insufficient clinical data to support some recommendations. Using specific goals of therapy for most patients with the diagnosis of diabetes, a population- based approach may benefit some but not all patients. Recommended targets of therapy or suggested medication use are not without risk to patients as they can potentially increase the risk for adverse drug reactions and drug–drug interactions. They may also increase drug costs to patients and lower medication adherence. The goals also carry implications to providers and healthcare systems. While population-based guidelines make some clinical decisions more practical, they do not take into consideration an individual’s overall cardiovascular risk. Individualized risk assessment to guide therapy decisions may optimize benefit while minimizing risk.