Fihn et al Stable Ischemic Heart Disease: Full Text e397 The role of emotional stress in relationship to hypertension has yet to be fully elucidated. It might be important to acknowledge the potential relationship of stress to many of the cardiovascular risk factors, particularly hypertension, when counseling patients. 4.4.1.3. Diabetes Management Class IIa 1. For selected individual patients, such as those with a short duration of diabetes mellitus and a long life expectancy, a goal hemoglobin A1c (HbA1c) of 7% or less is reasonable.574 576 (Level of Evidence: B) 2. A goal HbA1c between 7% and 9% is reasonable for certain patients according to age, history of hypo- glycemia, presence of microvascular or macrovascu- lar complications, or presence of coexisting medical conditions.577,578 (Level of Evidence: C) Class IIb 1. Initiation of pharmacotherapy interventions to achieve target HbA1c might be reasonable.456,579 588 (Level of Evidence: A) Class III: Harm 1. Therapy with rosiglitazone should not be initiated in patients with SIHD.589,590 (Level of Evidence: C) Diabetes mellitus is an important independent risk factor for cardiovascular disease. 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. 