Given concerns about higher mortality rate, Fihn et al Stable Ischemic Heart Disease: Full Text e423 particularly in patients .75 or 80 years of age, decisions to recommend revascularization should be undertaken only after careful consideration of patient preferences, functional capac- ity, quality-of-life and end-of-life issues, as well as therapeu- 5.12.3. Diabetes Mellitus Type 1 and type 2 diabetes mellitus are associated with a greater risk of SIHD, and the effects of other risk factors such as hypercholesterolemia are magnified.1170 Cardiovascular mortality rate is 3-fold higher in men with diabetes mellitus and between 2- and 5-fold higher in women with diabetes than in patients without diabetes mellitus.1171,1172 Sudden cardiac death occurs more frequently in patients with diabetes mellitus. Although direct evidence is lacking, asymptomatic ischemia could be more prevalent in patients with diabetes mellitus, possibly because of autonomic neuropathy.1173 The risk of death in a patient with SIHD and diabetes mellitus has been equated to the risk of death in a patient with SIHD and a previous MI.1171,1174 Aggressive management of cardiovascular risk factors, including hypercholesterolemia, hypertension, smoking, low physical activity, and obesity, is essential, along with appropriate glycemic control. Among patients with IHD, the presence of concomitant diabetes mellitus increases the risk of adverse events, irre- spective of whether the patient is treated medically or with revascularization. 