Prevention and noninvasive management of coronary atherosclerosis in patients with diabetes.
Diabetes mellitus (DM) is a worldwide epidemic. Its prevalence is rapidly increasing in both developing and developed countries. Coronary heart disease (CHD) is highly prevalent and is the major cause of morbidity and mortality in patients with diabetes. Individuals with prediabetes states, with or without known CHD, should undergo lifestyle modifications aimed at preventing DM. In patients with CHD and DM, routine use of aspirin and an angiotensin-converting enzyme inhibitor, along with strict glycemic, blood pressure, and lipid control, is strongly recommended. Intense insulin therapy may be needed for glycemic control, and high-dose statin therapy may be needed for lipid control. For blood pressure control, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are considered first-line therapy. Noncompliance with medications and/or lifestyle measures and underprescription of evidence-based therapies remain important unsolved problems.
Bourassa
Martial G
MG
Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, Canada H1T 1C8. martial.bourassa@icm-mhi.org
Berry
Colin
C
D000959:Antihypertensive Agents / Q000627:therapeutic use; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000188:drug therapy / Q000517:prevention & control*; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007333:Insulin Resistance / Q000502:physiology; D008019:Life Style; D009203:Myocardial Infarction / Q000517:prevention & control; D009765:Obesity / Q000453:epidemiology; D000077205:Pioglitazone; D010880:Piperidines / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011236:Prediabetic State / Q000453:epidemiology; D011720:Pyrazoles / Q000627:therapeutic use; D017257:Ramipril / Q000627:therapeutic use; D000077285:Rimonabant; D018570:Risk Assessment; D045162:Thiazolidinediones / Q000627:therapeutic use; D014280:Triglycerides / Q000097:blood; D015431:Weight Loss
D000959:Antihypertensive Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D010880:Piperidines; D010975:Platelet Aggregation Inhibitors; D011720:Pyrazoles; D045162:Thiazolidinediones; D014280:Triglycerides; D017257:Ramipril; D000077285:Rimonabant; D000077205:Pioglitazone