Interventions for patients with diabetes mellitus

Summary

Diabetes mellitus is considered to be a “coronary heart disease equivalent” due to its increased atherothrombotic risk related to the pro-inflammatory and prothrombotic features of the disease. Current pharmacological treatments appear to be less efficacious in diabetics as compared to non-diabetics. The so-called phenomenon of antiplatelet resistance may play a role in this regard. New antiplatelet drugs may exhibit some advantages over the classical regimens. Coronary artery disease in diabetic patients is often more diffuse and more severe than in non-diabetics, resulting in poorer outcomes after revascularisation. Classically, coronary artery bypass grafting has been the revascularisation treatment of choice in diabetics with multivessel disease. Although the advent of drug-eluting stents has narrowed the gap between surgery and the percutaneous treatment, the former remains the gold standard in diabetics with diffuse coronary artery disease. However, despite these advances in coronary revascularisation, strict and refined metabolic control is the cornerstone to prevent progression of coronary artery disease in diabetic patients. This chapter reviews all the aforementioned aspects relating to the treatment of coronary artery disease in diabetic patients.

Introduction: diabetes mellitus, a cardiovascular disease

Diabetes mellitus (DM) currently affects 150 million people worldwide and has an increasing incidence 1