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[Diabetes and ischemic cardiopathy]
F Piscione1, E Barbato, G Galasso
1Cattedra di Cardiologia Università degli Studi Federico II Via S. Pansini, 5 80131 Napoli. piscione@unina.it
Insights
Diabetes significantly worsens coronary artery disease (CAD) outcomes and increases heart attack risk. Optimal management involves controlling blood sugar, lipids, blood pressure, and coagulation factors.
Area of Science:
- Cardiology
- Endocrinology
- Vascular Biology
Context:
- Diabetes mellitus is a major independent risk factor for coronary artery disease (CAD).
- Diabetic patients with CAD exhibit poorer survival rates and a higher incidence of acute coronary events.
- Diabetics present with accelerated and more severe atherosclerotic vascular disease.
Purpose:
- To review the complex interplay between diabetes and CAD.
- To discuss the multifactorial nature of ischemic vascular disease in diabetes.
- To highlight current and emerging therapeutic strategies for managing CAD in diabetic patients.
Summary:
- Diabetes exacerbates atherosclerosis, leading to increased risk of plaque ulceration and thrombus formation.
- Abnormalities in coronary vessel structure, flow, and coagulation contribute to severe vascular disease in diabetics.
- Effective treatment requires comprehensive management of hyperglycemia, dyslipidemia, hypertension, and hemostatic dysregulation.
Impact:
- Optimal therapeutic strategies necessitate aggressive correction of all risk factors.
- Both percutaneous coronary intervention and surgical revascularization are effective, with recent data favoring surgery.
- Targeting advanced glycation end-products offers novel treatment avenues, underscoring the need for further clinical trials.
Abstract:
Diabetes represents an independent risk factor for coronary artery disease (CAD), and the prognosis in terms of survival rates is worse for diabetic patients who have CAD with respect to those with CAD but no diabetes. An acute coronary event represents a cause of death in more than 30% of diabetics. Experimental studies suggested that the increased incidence of myocardial infarction in diabetics is due to an increased risk of developing atherosclerotic plaque with subsequent ulceration and intracoronary thrombus formation. Structural abnormalities of the coronary vessel wall were associated with an abnormal pattern of coronary flow and of coagulation abnormalities: all these abnormalities explain the epidemiological evidence of widespread and severe vascular atherosclerotic disease in diabetics. Due to the extreme complexity of ischemic vascular disease in patients with diabetes, an optimal therapeutic strategy is based on the correction of elevated blood glucose and lipid levels, of blood pressure, of platelet and coagulation abnormalities and of any other risk factor. Both percutaneous and surgical myocardial revascularization have been proved equally effective for CAD treatment in diabetes, even though a recent randomized trial has shown a significantly improved outcome after surgical revascularization. More recently the characterization of the advanced glycation end-product receptor opened new perspectives in the treatment of the complications of diabetes, and gave a new impact to the need of further investigations, through new randomized trials, of the best therapeutic options for diabetic patients.