Should we prescribe statin and aspirin for every diabetic patient? Is it time for a polypill?

There is clear evidence that diabetic patients constitute a group at high cardiovascular risk. Epidemiologic data show that with the aging of the European population, the percentage of diabetic patients will increase in the upcoming years, with important consequences for cardiovascular mortality. Therefore, the question arises, “How aggressive should prevention with statins and aspirin in diabetic patients be?” As several studies have demonstrated, cardiovascular mortality of diabetic patients is as high as in nondiabetic patients with known coronary artery disease (1– 3); thus, the term “coronary artery disease risk equivalent” has been introduced. A coronary artery disease risk equivalent implicates the need for stronger treatment goals of secondary prevention for cardiovascular risk factors. A further debate is whether medical treatment provided to patients with coronary heart disease should also be given to diabetic patients without known coronary heart disease.