Non-insulin-dependent diabetes mellitus and cardiovascular risk

Patients with non-insulin-dependent mellitus (NIDDM) have a two- to threefold increased risk of cardiovascular death compared with non-diabetic persons. This increased risk is already present at diagnosis and cannot explained by classic risk factors such as blood pressure, serum cholesterol or smoking. The risk of death from cardiovascular disease may or may not, depending on age, gender and other risk factors, be less than 1% per annum in patients with NIDDM but without evidence of cardiovascular disease. In patients with cardiovascular disease, the risk of death is approximately 4% per annum. None of the secondary preventive measures, including intensive insulin therapy (which is not permitted in aviators), lipid-lowering drugs, beta-blocking agents, angiotensin-converting enzyme inhibitors or coronary artery bypass grafting can reduce the annual risk of cardiovascular disease in such patients to below the level required for aviation certification.