[Diabetes mellitus and ischemic heart disease]

Diabetes mellitus (DM) is closely associated with cardiovascular (CV) diseases. These are the main cause of death in patients not only with type 2 but also type 1 diabetes. Apart from the traditional risk factors such as arterial hypertension, dyslipidemia and obesity, hyperglycaemia is an independent risk factor for the development of ischemic heart disease (IHD). Long-term hyperglycaemia leads to vascular damage through several mechanisms. These include oxidative stress, formation of advanced glycation end products, activation of the nuclear factor kappa B and decreased production of nitrogen monoxide (NO). Insulin resistance is believed to have an important bearing on pathogenesis of IHD in type 2 diabetes (DM2) patients. The course of IHD in diabetic patients is usually more complicated. Direct percutaneous coronary intervention (PCI) is the gold standard in the treatment of myocardial infarction (MI) in diabetic as well as non-diabetic patients. Drug-eluting stents, associated with fewer reocclusions, have also proved useful. In addition to drug-eluting stent implantation, surgical revascularization, preferably utilizing internal thoracic artery, is a suitable technique in patients without acute coronary syndrome indicated for an intervention. Conservative approach should be applied in less severely affected patients. IHD prevention should include appropriate control of arterial hypertension, dyslipidemia and weigh reduction. Diabetes treatment should be managed individually and with respect to the potential risk of hypoglycaemia in high-risk patients with longer duration of diabetes and known CV disease. Newly diagnosed type 2 diabetes patients should from the onset be treated with metformin and tight compensation should be aimed for with target value for glycated haemoglobin of less than 4.5% (IFCC methodology). Evidence exists that this approach may significantly reduce the CV risk. Intensified insulin regimen is the most suitable treatment approach for the type 1 diabetes patients also with respect to microvascular and macrovascular complication prevention. Treatment of hyperglycaemia is one of the set of measures that may contribute to CV risk reduction in diabetic patients.