Vascular disease and diabetes: the change in emphasis in the last 20 years

The approach to vascular disease in people with diabetes has been transformed in the last 20 years. Epidemiological studies have confirmed the excessive morbidity and mortality from cardiovascular disease in type 2, and more recently in type 1, diabetes. Many pharmacological studies have shown that this excess risk can be reduced by reduction of blood pressure or cholesterol, but blood glucose lowering studies have been few in number and disappointing in vascular outcomes. Modern cardiological interventions are also beneficial in this high‐risk group of patients. Looking forward to the next 20 years, two key areas for further study can be identified: a greater understanding of the pathophysiology, prevention and treatment of vascular disease in type 1 diabetes, and more information on the pathophysiology and treatment of stroke disease in all forms of diabetes. Copyright © 2004 John Wiley & Sons, Ltd.