[Prevention and treatment of ischemic heart disease in patients with diabetes mellitus].
The incidence of cardiovascular diseases among diabetic patients is so high that diabetes mellitus is currently defined as a cardiovascular disease equivalent. Furthermore, diabetic patients who develop acute coronary syndromes have a poorer short-term and long-term prognosis, so primary and secondary preventive measures are critically important in this population subgroup. There is substantial evidence that pharmacological therapy for primary and secondary cardiovascular prevention is more effective in diabetic patients than in non-diabetics. This article reviews the evidence of the efficacy of pharmacological prevention therapies in diabetic patients in favor of an aggressive pharmacological preventive strategy. Every diabetic patient without known cardiovascular disease should be treated with angiotensin-converting enzyme inhibitors and statins. High-risk patients should also receive low-dose aspirin.Compared with non-diabetics, diabetic patients who develop acute coronary events benefit more from the addition of intensive antithrombotic therapy to aspirin treatment. Diabetic patients presenting with non-ST segment elevation syndromes have better outcomes when treated with clopidogrel or glycoprotein IIb/IIIa inhibitors, and diabetics presenting with ST-segment elevation or left bundle-branch block have a greater survival benefit when given thrombolytic therapy compared with non-diabetic patients.Unless formal contraindications are present, diabetic patients with ischemic heart disease, particularly those with previous myocardial infarction, should always be treated with aspirin, betablockers, angiotensin converting enzyme inhibitors, and statins, regardless of lipid levels, left ventricular systolic function or the presence of congestive heart failure.
Bueno
Héctor
H
Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain. hecbueno@jet.es
D003327:Coronary Disease / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D017202:Myocardial Ischemia / Q000097:blood / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D012307:Risk Factors
D005343:Fibrinolytic Agents