Should We Prescribe Statin and Aspirin for Every Diabetic Patient? Is it time for a polypill? HARM WIENBERGEN, MD

There is clear evidence that diabeticpatients constitute a group at highcardiovascular risk. Epidemiologic data show that with the aging of the Eu-ropean population, the percentage of di-abetic patients will increase in the upcoming years, with important conse-quences for cardiovascular mortality. Therefore, the question arises, “How ag-gressive should prevention with statins and aspirin in diabetic patients be?” As several studies have demonstrated, cardiovascular mortality of diabetic pa-tients 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 equiv-alent implicates the need for stronger treatment goals of secondary prevention for cardiovascular risk factors. A further debate is whether medical treatment pro-vided to patients with coronary heart dis-ease should also be given to diabetic patients without known coronary heart disease. ASPIRIN — Aspirin administration as secondary prevention in coronary heart disease is well established. The beneficial effect of aspirin therapy in secondary pre-vention of coronary heart disease has been demonstrated by the meta-analysis of the Antithrombotic Trialist ’ Collabora-tion in 2002, with a total relative risk re-duction of 15 % for cardiovascular death and of 28 % for nonfatal re-infarction (4