[Coronary artery disease associated to diabetes mellitus]

Diabetes mellitus represents a major coronary risk factor. Diabetes promotes atherosclerotic plaque development through different mechanisms among which oxidative stress induced by hyperglycaemia appears to play a major role. Knowledge of pathophysiologic mechanisms associated with diabetes helps to better understand the rationale for treatment. Besides a tight control of all cardiovascular risk factors, prescription of drugs aiming of stabilization or even reduction of atherosclerosis should be systematically recommended. These drugs include statines, ACE inhibitors and aspirin eventually combined with clopidogrel. The use of beta blockers should be encouraged in case of stable angina. Finally, any patient with symptomatic modification suggesting acute coronary syndrome should be considered for myocardial revascularization.