[State-of-the-art in the treatment of chronic coronariopathy in diabetic patients: evidences and controversies based in clinical trials].
Diabetes mellitus is a powerful risk factor for coronary artery disease. Diabetics demonstrate accelerated coronary atherosclerosis and worst prognosis following cardiac events. Although myocardial revascularization procedures result in more effective relieve of symptoms in patients with known coronary artery disease, there is no substantial evidence that this strategy improves outcome, except for specific situations. In addition, the benefit of myocardial revascularization is attenuated by the presence of metabolic abnormalities related to insulin resistance and other significant co-morbidities in diabetic patients. New advances recently developed for the clinical treatment of diabetes, as well as surgical and percutaneous approaches of myocardial revascularization, such as drug-eluting stents, seem to be promising therapeutical strategies for diabetic patients. Most importantly, treatment of type 2 diabetics with chronic coronary artery disease should consider the multifactorial pathogenesis of the disease and combine aggressive control of glycemic levels, strict management of all conventional risk factors, and lifestyle modification. The metabolic effects of insulin sensitizers over cardiovascular disease and mortality are under discussion. Ongoing clinical multicenter trials will probably define the real impact of new therapeutic modalities over the prognosis of diabetic patients.
Lopes
Neuza H
NH
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. mass@incor.usp.br
Tsutsui
Jeane M
JM
Hueb
Whady A
WA
D015906:Angioplasty, Balloon, Coronary; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy; D003925:Diabetic Angiopathies / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D015337:Multicenter Studies as Topic; D009204:Myocardial Revascularization; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors