Before we ask a patient to take any drug we should be confident that the benefits outweigh the risks. This involves considerations like duration of therapy and whether the drug is being used to treat a disease versus prevent it. But even more important is an understanding of how the pharmacology of the drug matches up to the pathophysiology of the disease. The better we understand both, the better we'll be at deciding when to use any drug for any disease.

In todays episode we apply these tenets of drug therapy to a common question, "does my patient with diabetes need to be on an ACEi or ARB?" To answer that question, we'll discuss the merits of drugs for disease prevention versus disease treatment. The use of risk factors for disease may or may not be sufficient to justify drug therapy. An LDL cholesterol of 220 is sufficient to initiate cholesterol lowering therapy. But is diabetes a sufficient reason to initiate an ACEi or ARB? We'll figure that out....and whether or not the answer surprises you, we'll learn things along the way that will be useful in virtually all settings of applied pharmacotherapy.