- Diabetes significantly accelerates the development and natural history of cardiovascular disease compared to individuals without diabetes. - Healthy behaviour interventions and pharmacological approaches aimed at cardiovascular disease risk reduction can significantly reduce morbidity and mortality, and are an important cornerstone of the management of diabetes. - Although young people with diabetes rarely have a high proximate (<10 year) risk for cardiovascular disease events, they have a relative proximate risk manyfold greater than individuals of similar age without diabetes. - Historically, pharmacological cardiovascular protection approaches have focused on low-density lipoprotein cholesterol and blood pressure reduction, and have demonstrated significant and clinically meaningful cardiovascular risk reduction. Recent data have indicated that certain antihyperglycemic agents are also cardioprotective. - The requirement for pharmacological cardiovascular protection therapies (statins, angiotensin-converting enzyme inhibitors or aldosterone receptor blockers, and anti-platelets) should consider both an individual's proximate and lifetime cardiovascular disease event risk. - There is emerging recognition that nonatherothrombotic cardiovascular disease complications, such as heart failure, are an important cause of morbidity and mortality in diabetes.- Ask your doctor about the ABCDEs to reduce your risk of heart attack and stroke: - A = A1C -Blood glucose control. The target is usually 7.0% or less. - B = BP -Blood pressure control (less than 130/80 mmHg). - C = Cholesterol -LDL-cholesterol less than 2.0 mmol/L. Your physician/ nurse practitioner may advise you to start cholesterol-lowering medication. - D = Drugs to protect your heart -These include blood pressure pills (ACE inhibitors or ARBs), cholesterol-lowering medication ("statins"), and, in people with existing cardiovascular disease, certain blood glucose lowering medications. These blood glucose-lowering medications can protect your heart even if your blood pressure and/or LDLcholesterol are already at target. - E = Exercise/Eating -Regular physical activity, which includes healthy eating, and achievement and maintenance of a healthy body weight. - S = Stop smoking and manage stress.# Introduction
Of the many complex complications of diabetes, adverse cardiovascular (CV) events have the greatest capacity to cause sudden or premature death and devastating disability. Myocardial infarction (MI), stroke and amputation are all manifestations of the aggressive atherosclerosis that can occur with diabetes. However, not every person with diabetes is at equal risk for CV atherosclerotic events and not everyone will benefit equally from healthy behaviour and pharmacological interventions intended to reduce cardiovascular disease (CVD) event risk. Over the last 2 decades, strong evidence has continued to accumulate that the CV risks of diabetes can be reduced significantly through comprehensive and treatment targetdriven risk factor modification (1)(2)(3)(4)(5). There is also growing appreciation that, in addition to atherothrombotic consequences, other CV disorders, such as heart failure, are an important cause of morbidity and mortality in diabetes.

# Determining CVD Event Risk
People with diabetes are clearly at increased risk of premature morbidity and mortality related to CVD (6). Diabetes confers a CVD event risk that is equivalent to aging approximately 15 years, with a transition from intermediate to high risk in men at age 47.9 years, and in women at 54.3 years (6). The term "vascular age" refers to models of CVD event risk that predict an individual's CVD event risk and compare the event risk to age-adjusted CVD event risk. Vascular age is a primary determinant in both proximate (<10 years) and lifetime risk of adverse CVD events. In people with diabetes with low-to-normal levels of blood pressure (BP), low-density lipoprotein cholesterol (LDL-C) and blood glucose (BG), chronological age and vascular age are usually in close continuity. However, in the presence of elevated levels of those same variables, together with smoking and physical inactivity, vascular age accelerates far more rapidly than chronological age.
As a powerful catalyst of vascular inflammation, diabetes is the disease state that accelerates vascular age at the greatest rate. Thus, the use of pharmacotherapy for CVD risk factor reduction in younger persons with diabetes who are not at a high proximate risk but, as a consequence of their diabetes, have a steep CVD event risk trajectory, can be justified by the potentially substantial long-term benefits of earlier and lifelong therapy (3)(4)(5)7,8).