Primary prevention of cardiovascular events and type 2 diabetes: should we prioritize our interventions?

The diagnosis of type 2 diabetes is based on elevated blood glucose levels. However, in most individuals, metabolic abnormalities as well as cardiovascular risk factors co-exist with a significant proportion of patients presenting with elevated blood pressure, high triglycerides and decreased HDL-cholesterol in addition to hyperglycemia. The risk of cardiovascular disease in people with type 2 diabetes is very high as cardiovascular death represents the number 1 killer in this population. An integrated approach controlling all risk factors as well as blood glucose has been demonstrated to effectively reduce the risk of cardiovascular complications. However, this requires the administration of multiple medications and some patients will have difficulties adhering to the prescribed regimen, limiting the number of drugs the physician can prescribe. In this review, we will summarize the efficacy of different approaches in primary prevention to help practitioners prioritize interventions in these situations.