Excess cardiovascular risk in patients with type 2 diabetes: do we need to look beyond LDL cholesterol?

Despite impressive advances in treatment, cardiovascular disease (CVD) remains a significant healthcare burden in the UK and worldwide. The clustering of CVD risk factors in patients with type 2 diabetes underlines the need for a multifactorial treatment approach, yet even when receiving optimal therapy according to best standards of care, there remains a substantial risk of CVD and microvascular disease. Risk prediction tools traditionally provide an estimate of risk over 10 years, however this approach is dominated by chronological age and gender and has a number of recognised limitations. A move from 10-year to lifetime risk calculation has been proposed, and should encourage intervention at a much earlier stage. This move, alongside aggressive and broad control of modifiable risk factors, aims to ease the burden of atherosclerosis prior to the manifestations of CVD. This will be of particular benefit to those with type 2 diabetes, who have been exposed to hyperglycaemia and other risk factors for extended periods of time. The atherogenic dyslipidaemia common in this group also ensures they will benefit most from treatment strategies under investigation to further reduce macrovascular and microvascular risk.