Previous clinical studies indicate that a cardiovascular risk reduction is difficult to achieve by aggressively controlling plasma glucose levels in diabetic patients.These studies suggested that the contribution of lowering glucose levels to the reduction of macrovascular events appears to be minimal, at least in the first few years of treatment. Although improved glucose control can protect against the development of microvascular complications, the absence
of a reduction in macrovascular events implicates an additive effect of nonglycemic
risk factors that often accompany diabetes, such as hypertension, hyperlipidemia, and hypercoagulability. Additional medications such as angiotensin-converting enzyme inhibitors, angiotensin II type 1 receptor blockers, statins, and antiplatelet agents may be needed in patients with type 2 diabetes mellitus. The JPAD trial indicates that
among these medications, aspirin is well tolerated for primary prevention and may
provide an additional low-cost option.