Cerebrovascular disease in type 2 diabetes

Type 2 diabetes is associated with at least 2-fold elevated risk for all macrovascular complications, coronary heart disease, stroke and peripheral vascular disease. The prevalence and incidence of hemorrhagic stroke is not higher among subjects with type 2 diabetes than in non-diabetic subjects. Therefore, an excess risk of stroke is due to high occurrence of ischemic strokes. High LDL cholesterol, elevated blood pressure, smoking, low HDL cholesterol, high levels of total triglycerides and insulin, central obesity, impaired glucose tolerance and atrial fibrillation have been associated with the risk of stroke. Diabetic patients with stroke should receive effective antihypertensive therapy, lipid-lowering medication, medication to obtain good glycemic control, and anti-platelet therapy. Surgical revascularization is indicated in patients with hemodynamically significant internal carotid artery atherosclerosis independently of symptoms. Patients with atrial fibrillation should be on anticoagulation therapy.