Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus.

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T he ongoing obesity epidemic and its impending cardiovascular consequences represent a serious public health problem with worrisome implications for medical treatment. The urgency of providing new research directions recently led the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to convene a Working Group on the Pathophysiology of Obesity-Associated Cardiovascular Disease. Gathered at this meeting were researchers with substantial experience and expertise in either obesity-related sciences, including epidemiology, endocrinology, and metabolism, or cardiovascular sciences, including cardiology, neurobiology, hematology, renal function, and pediatrics. This report is the culmination of the blending of ideas during the 2-day meeting. The resulting research recommendations include the development of new models and synergistic approaches to basic studies of obesity-associated cardiovascular diseases. BackgroundThe adult US population, whose combined prevalence of overweight and obesity now exceeds 60%, 1 is experiencing an unprecedented exposure to obesity-related cardiovascular risk factors and is expected to suffer the adverse clinical consequences in years to come. Also alarming are the ever-rising rates of overweight and obese children and adolescents, which have tripled over the last 30 years. 2 Increased rates of co-morbidities such as dyslipidemia, hypertension, type 2 diabetes, and hepatic damage in overweight adolescents indicate that the young are not protected from the metabolic perturbations that accompany excess adipose tissue stores. [3][4][5] We do not know what the consequences might be for the developing cardiovascular system if obesity is present during late stages of growth and maturation.Overweight or obese individuals experience greatly elevated morbidity and mortality from nearly all of the common cardiovascular diseases (stroke, coronary heart disease, congestive heart failure, cardiomyopathy, and possibly arrhythmia/sudden death). 6,7 Because primary treatment and prevention of obesity often fail or are only partially successful, it is anticipated that the future will bring ever-increasing demands to treat the cardiovascular conditions attributable to obesity. Thus, to develop rational therapeutic approaches, we need to understand the basic biology of obesity-related cardiovascular diseases and disorders. Discussion HighlightsThe Working Group's multi-disciplinary panel of clinical and basic scientists was charged with evaluating the current state of the science on basic mechanisms of obesity-associated cardiovascular disease and identifying research opportunities with a focus on potential therapeutic applications. The group was encouraged to translate problems identified through population and clinical research into clear priorities for mechanistic research. Mechanistic Studies in Animals and Humans Adipose Tissue as a Metabolically Active Endocrine OrganThe predominant role of adipose tissue is the storage ...

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