Diabetic nephropathy: can renoprotection be extrapolated to cardiovascular protection?

Recent years have seen the seemingly unstoppable attack by cardiologists on all diseases that limit cardiovascular health. Nowhere is this more evident than in the case of diabetes mellitus, the subject of an important article in this issue of Circulation1 that relates to renoprotection in type 2 diabetes mellitus. As a background, type 2 diabetes is increasing in incidence and cardiological significance, particularly because of the finding that blood pressure control is crucially important in limiting the macrovascular disease that shortens life in patients with type 2 diabetes.2 As a negative prognostic factor, patients with type 2 diabetes without prior myocardial infarction have as high a risk of infarction as do nondiabetics with prior infarction.3 The adverse effects of type 2 diabetes are accelerated by diabetic nephropathy leading to a nearly 9-fold increase in relative cardiovascular mortality.4