Type 1 diabetes mellitus is associated with at least a 10-fold increase in cardiovascular events,591,592 and patients with type 2 diabetes mellitus have a risk of death from cardiovascular causes that is 2 to 6 times that of persons without diabetes mellitus.593 595 The complications of athero- sclerosis account for 80% of deaths among patients with diabetes mellitus, and IHD is responsible for the majority of deaths.574,596 Diabetes mellitus is associated with a poor outcome in patients with SIHD, even after the extent of disease and other clinical characteristics are taken into ac- count. In the CASS registry, for example, patients with diabetes mellitus had a 57% greater risk of death after adjustment for other risk factors.597 Clinical trials have demonstrated a salutary effect of intensive glycemic control on the development of microvas- cular complications of diabetes mellitus, such as retinopathy, nephropathy, and peripheral and autonomic neuropa- thy,574,575,598 with secondary analyses suggesting a benefit extending into the normal range of HbA1c. However, the efficacy of intensive diabetes therapy in reducing cardiovas- cular disease is less well established. In the DCCT (Diabetes Control and Complications Trial), patients with type 1 dia- betes mellitus were randomized to intensive (mean achieved therapy. 