Cardiovascular disease is by far the most important complication of diabetes. Strong evidence has accumulated to indicate that ischemic heart disease in diabetics, particularly in the post–myocardial infarction setting, is associated with an increased incidence of congestive heart failure (CHF), aggravating the outcome. The prognosis of diabetics with CHF is poor and requires careful evaluation of patients to identify those liable to benefit most from early treatment. The pharmacological treatment of these patients does not fundamentally differ from that of the nondiabetic population (diuretics and angiotensin-converting enzyme [ACE] inhibitors), and should include optimal titration of treatment and use of maximum tolerated doses of ACE inhibitors and β-blockers. Results of ongoing trials will define whether angiotensin receptor blockers can further improve the long-term prognosis of this high-risk population...