Type 2 diabetes mellitus is a global epidemic. Patients with this chronic disease—which they typically have for 20–40 years—have an increased risk of cardiovascular events. During the past few years, advances in drug development and the completion of several large-scale, randomized controlled trials have helped to provide strategies to reduce the risk of cardiovascular events in this group of patients. This collection of articles from Nature Reviews Cardiology and Nature Reviews Endocrinology provides a state-of-the-art overview of current management strategies to reduce the risk of cardiovascular events in patients with type 2 diabetes mellitus and will be a welcome resource to researchers and clinicians alike.

The collection is accompanied by a library of articles on cardiovascular risk reduction in type 2 diabetes mellitus published by the NPG journals.


REVIEWS

Diabetes mellitus and periodontitis: a tale of two common interrelated diseases

Evanthia Lalla &Panos N. Papapanou

doi:10.1038/nrendo.2011.106

Nature Reviews Endocrinology, advance online publication, Published online 28 June 2011

Diabetes mellitus is an established risk factor for periodontitis, and periodontitis can adversely affect glycemic control. This Review discusses the complex relationship between these two conditions and the implications of this association for patients and health-care professionals.

Type 2 diabetes mellitus—current therapies and the emergence of surgical options

Harold E. Lebovitz

doi:10.1038/nrendo.2011.10

Nature Reviews Endocrinology 7, 408-419 (2011)

New antidiabetic agents enable many patients with type 2 diabetes mellitus (T2DM) to achieve target HbA1c levels. However, a range of factors can interfere with the ability of some patients to reach metabolic targets. This Review discusses the current therapies for patients with T2DM and assesses the relative benefits and risks of surgical treatment of overweight and obese patients with T2DM.

Lipid control in patients with diabetes mellitus

D. John Betteridge

doi:10.1038/nrcardio.2011.23

Nature Reviews Cardiology 8, 278-290 (2011)

Patients with type 1 or type 2 diabetes mellitus are at increased risk of cardiovascular disease (CVD). In this Review, the author discusses available data from randomized controlled trials of statins and other dyslipidemia-management agents that provide a framework to guide primary and secondary prevention of CVD in these populations.

Oxidative stress in early diabetic nephropathy: fueling the fire

Dhruv K. Singh , Peter Winocour & Ken Farrington

doi:10.1038/nrendo.2010.212

Nature Reviews Endocrinology 7, 176-184 (2011)

This Review summarizes the role of reactive oxygen species and oxidative stress in diabetes mellitus and in the pathogenesis of endothelial cell dysfunction and diabetic nephropathy. Furthermore, the authors explore possible therapeutic interventions to reduce oxidative stress and endothelial cell dysfunction and retard the progression of diabetic nephropathy.

Blood pressure lowering in patients with diabetes—one level might not fit all

Rhonda M. Cooper-DeHoff, Eric F. Egelund & Carl J. Pepine

doi:10.1038/nrcardio.2010.182

Nature Reviews Cardiology 8, 42-49 (2011)

Blood pressure (BP) targets in patients with hypertension and diabetes mellitus have generally been based on global guidelines. However, these targets are often aggressive, and do not consider the patient's individual risk. Some studies have indicated that intensive BP lowering might not always reduce the risk of cardiovascular events. The authors of this Review present the evidence both for and against intensive BP lowering therapy, and suggest a personalized approach to treatment in the future.

Epigenetic phenomena linked to diabetic complications

Luciano Pirola, Aneta Balcerczyk, Jun Okabe & Assam El-Osta

doi:10.1038/nrendo.2010.188

Nature Reviews Endocrinology 6, 665-675 (2010)

The findings from the DCCT–EDIC and UKPDS epidemiological studies suggest that early exposure to hyperglycemia predisposes individuals to the development of diabetic complications, a phenomenon referred to as metabolic memory or the legacy effect. Transient exposure to hyperglycemia results in long-lasting epigenetic modifications that lead to changes in chromatin structure and gene expression, resulting in vascular dysfunction.

Aspirin for primary prevention of cardiovascular disease in diabetes mellitus

Michael Pignone & Craig D. Williams

doi:10.1038/nrendo.2010.169

Nature Reviews Endocrinology 6, 619-628 (2011)

This Review addresses the pharmacology and physiology of aspirin use and how it may differ in patients with diabetes mellitus. The clinical trial evidence for the primary prevention of cardiovascular disease with aspirin therapy in patients with diabetes mellitus will then be examined in light of these potential mechanisms. Finally, suggestions for clinical practice are provided, and the limitations in current evidence as well as the upcoming trials that may help resolve these important clinical issues are highlighted.

Salt, aldosterone, and insulin resistance: impact on the cardiovascular system

Guido Lastra, Sonal Dhuper, Megan S. Johnson & James R. Sowers

doi:10.1038/nrcardio.2010.123

Nature Reviews Cardiology 7, 577-584 (2010)

Excess dietary salt is associated with insulin resistance and hypertension, and may lead to type 2 diabetes, cardiovascular disease and chronic kidney disease. The mechanisms underlying the pathogenic effects of salt on the cardiovascular system include impaired glucose homeostasis and activation of the sympathetic nervous system and renin–angiotensin–aldosterone system. Mineralocorticoid receptor blockers are promising therapies to counteract the adverse metabolic and cardiovascular effects of salt.

Intensive glycemic control and cardiovascular disease: an update

Aparna Brown, L. Raymond Reynolds & Dennis Bruemmer

doi:10.1038/nrcardio.2010.35

Nature Reviews Cardiology 7, 369-375 (2010)

This Review discusses the effects of intensive glycemic control on cardiovascular disease in patients with diabetes, and examines key factors in recent intervention trials that might have contributed to their disparate findings. The authors suggest that care of these patients should focus on achieving current treatment goals, rather than on changes to glycemic targets.

YEAR IN REVIEW

Type 2 diabetes mellitus in 2010: Individualizing treatment targets in diabetes care

John B. Buse

doi:10.1038/nrendo.2010.230

Nature Reviews Endocrinology 7, 67-68 (2011)

The majority of patients with type 2 diabetes mellitus have uncontrolled glycemia, blood pressure and lipid levels and struggle to achieve targets set by current guidelines. In 2010, subgroup analyses of the ACCORD trial further underscored the need to tailor treatment to each individual.

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