Ischemic heart disease in type 2 diabetes.
Type 2 diabetes has reached epidemic proportions and an increasing proportion of patients with coronary artery disease (CAD) are diabetics. CAD in diabetics has specificities and, in particular, more extensive atherosclerosis; diabetic patients are also more frequently asymptomatic, with silent myocardial ischemia, which makes the diagnosis of CAD more difficult. In addition, diabetic patients with CAD have poorer outcomes than nondiabetics. The management of diabetic patients with CAD is based on intensive intervention on lifestyle and risk factors, together with the mandatory use of medications of proven benefit as regards secondary prevention in coronary patients: antiplatelet agents, statins, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors. Glycemic control is also essential; although the use of sulfonylureas has been controversial, there is now a vast amount of data suggesting a beneficial effect, in particular when agents more specific for the pancreatic adenosine triphosphate-dependent potassium (K(ATP)) channels are used. At the acute stage of myocardial infarction, the Diabetes mellitus, Insulin Glucose infusion in Acute Myocardial Infarction (DIGAMI) trial suggested a beneficial effect of insulin therapy prolonged for 3 months after hospital discharge; these data will have to be confirmed by larger intervention trials. Finally, the respective roles of coronary angioplasty and coronary surgery in diabetics are debated; a post hoc analysis of the Bypass Angioplasty Revascularization Investigation (BARI) trial data showed increased mortality in diabetics with multivessel CAD treated with angioplasty compared with surgery, but the results of the more recent trials using intracoronary stents appear more balanced; in this regard, the effects of drug-eluting stents, which dramatically decrease the incidence of re-stenosis, seem promising.
Otel
Irina
I
Department of Cardiology, Hôpital Européen Georges Pompidou, Paris, France.
Ledru
François
F
Danchin
Nicolas
N
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000209:etiology*; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D009204:Myocardial Revascularization; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D013453:Sulfonylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D010975:Platelet Aggregation Inhibitors; D013453:Sulfonylurea Compounds