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An increased hemoglobin A1c level in patients with diabetes mellitus is associated with an increased incidence of ischemicstroke, increased severity of coronary artery disease, and an increased severity of peripheral arterial disease. Results from5 prospective clinical trials which randomized diabetics to intensive blood glucose control or to standard blood glucosecontrol and one retrospective observational study of 26,673 diabetics are discussed. The 5 clinical trials were the UnitedKingdom Prospective Diabetes Study, the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventionand Complications Study, the Action to Control Cardiovascular Risk in Diabetes Study, the Action in Diabetes andVascular Disease: Preterax and Diamicron Modifies-Release Controlled Evaluation Study, and the Veterans Affairs DiabetesTrial. Severe hypoglycemia may be associated with cardiovascular events and mortality. Recommendations from the 2007 scientific statement from the American Heart Association and the American Diabetes Association, the 2011 AmericanHeart Association/American College of Cardiology Foundation secondary prevention guidelines in patients with coronaryand other atherosclerotic vascular disease, the 2013 American Diabetes Association guidelines, and the 2013 AmericanGeriatrics Society guidelines for improving the care of older adults with diabetes mellitus are also discussed.

Numerous studies have shown that statins reduce cardiovascular events including stroke and mortality in diabetics. The American Diabetes Association 2013 guidelines recommend that diabetics at high risk for cardiovascular events should have their serum low-density lipoprotein (LDL) cholesterol reduced to

Most studies have reported a dose-dependent reduction in bloodpressure after decreasing sodium intake with the greatest reductionin blood pressure occurring in patients with the highestblood pressures and the most successful interventions. Ameta-analysis of 56 randomized controlled trials showed a meanblood pressure reduction of 3.7/0.9 mm Hg for a 100 mmol/dayreduction in sodium excretion.