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Keywords:

  • diabetes;
  • strokes;
  • hypertension;
  • ACE inhibitors;
  • statins

Abstract

Cardiovascular disease is the most common cause of morbidity and mortality in people with diabetes. Coronary heart disease is a common cause of death, and has been extensively studied in people with diabetes. Stroke is at least twice as common in people with diabetes than non-diabetic subjects, and is a common cause of morbidity and disability, but has been comparatively neglected. Limited studies suggest that the pathophysiology of stroke may differ in people with diabetes, with disseminated cerebral small vessel disease. Control of hyperglycaemia has shown limited benefit in reducing the development of strokes. A substantial evidence base demonstrates the benefit of aggressive blood pressure lowering in reducing stroke disease in people with diabetes, and ACE inhibitors may have extended benefit in reducing stokes and other forms of vascular disease beyond the reduction in blood pressure. Cholesterol lowering with statins has been shown to reduce strokes when used as secondary prevention in diabetic patients with coronary heart disease. More recently, this has also been proven to be beneficial for the primary prevention of strokes in people with diabetes. A non-invasive screening test for cerebrovascular disease would be useful in people with diabetes. Copyright © 2005 John Wiley & Sons, Ltd.