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[Treatment of diabetic patients with ischaemic heart disease]
P R Hildebrandt1, O Snorgaard, T M Melchior
1H:S Frederiksberg Hospital, kardiologisk-endokrinologisk klinik E.
Insights
Patients with diabetes have a higher risk of heart events. Standard treatments offer similar relative benefits, but greater absolute benefits, yet are underutilized in this population.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Syndrome
Context:
- Diabetes significantly increases the risk of cardiovascular events and mortality in patients with ischaemic heart disease.
- Patients with diabetes often experience greater absolute risk, necessitating tailored cardiovascular interventions.
- Despite similar relative benefits from standard treatments (thrombolysis, aspirin, beta-blockers, ACE inhibitors, statins), their utilization is less common in diabetic patients.
Purpose:
- To highlight the increased cardiovascular risk in diabetic patients with ischaemic heart disease.
- To emphasize the underutilization of evidence-based cardiovascular interventions in this high-risk group.
- To explore direct metabolic interventions for ischaemic heart disease in diabetic patients.
Summary:
- Subgroup analyses indicate that standard cardiovascular interventions provide significant absolute benefits in diabetic patients due to their higher baseline risk.
- The DIGAMI study demonstrated reduced mortality with glucose/insulin treatment followed by insulin therapy compared to conventional care.
- Ongoing research, such as the DIGAMI-2 study, aims to further validate the efficacy of metabolic interventions in managing ischaemic heart disease in diabetes.
Impact:
- Increased awareness and correction of underutilization of proven cardiovascular therapies in diabetic patients.
- Potential for improved clinical outcomes and reduced mortality through targeted metabolic interventions.
- Advancement of evidence-based guidelines for managing cardiovascular disease in the growing diabetic population.
Abstract:
Patients with diabetes constitute a large group among patients with ischaemic heart disease, and their risk of repeated cardiovascular events is large. Due to this, there is increasing focus on intervention against the increased risk of cardiac morbidity and mortality in patients with diabetes. Subgroup analyses of patients with diabetes from studies on patients with ischaemic heart disease show that intervention with thrombolysis, aspirin, beta blockers, ACE inhibitors and statins have similar relative benefit among patients with diabetes, but because of the greater risk in these patients, the absolute benefit is increased. In spite of this, intervention is less common among patients with diabetes, a fact that should be corrected. Direct intervention targeted at the metabolic disorder in ischaemic heart disease has only been investigated in the DIGAMI study, where glucose/insulin treatment followed by long term treatment with insulin was compared to conventional treatment. The mortality was lower in the insulin treated group after one to four years of follow up, a promising result which is currently being investigated in the DIGAMI-2 study.