Hyperglycemia, dyslipidemia and hypertension in older people with diabetes: the benefits of cardiovascular risk reduction

Aging and diabetes have a profound effect on cardiovascular system structure and function increasing the risk for cardiovascular disease (CVD). With increasing age there is increased stiffness and loss of compliance of major arter­ ies, leading to the development of systolic hyper­ tension and wide pulse pressure. This vascular aging could be genetic [1] or influenced by adverse growth patterns in early postnatal life [2]. On the other hand, the increased risk of CVD caused by diabetes is not fully explained by the traditional risk factors, and there is some evidence to suggest that abnormalities in insulin­like growth factor­1 occur in insulin­resistant states and may be a sig­ nificant factor in the pathophysiology of CVD [3]. This may occur even before clinical diabetes is diagnosed, and affects individuals with impaired glucose tolerance [4]. The prevalence of coronary heart disease (CHD) is around 80% of elderly people with Type 2 diabetes [5], and the incidence is twice that in nondiabetic elderly patients [6]. As the combination of both diabetes and age places older people with diabetes at the highest baseline risk for CVD, this population stands to gain the most benefit from cardiovascular risk reduction. Although the evidence for cardiovascular risk reduction in diabetics is established for younger patients, there is still some uncertainty for how far we should go with risk reduction in older people, as most of the clinical trials have excluded or only included few of these patients [7]. We have performed a Medline review for the evidence of major cardiovascular risk reduction relevant to older people with diabetes using the following search terms individually and in combination: diabetes mellitus, hyperglycemia, blood glucose, elderly, older people, aged, vascular risk, cardio­ vascular risk, hypertension, hypercholestrolemia, hyperlipidemia, dyslipidemia.