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Review
. 2014 Aug;32(3):439-55.
doi: 10.1016/j.ccl.2014.04.001. Epub 2014 Jun 10.

Coronary artery disease and diabetes mellitus

Doron Aronson  1 , Elazer R Edelman  2
Affiliations
Review

Coronary artery disease and diabetes mellitus

Doron Aronson et al. Cardiol Clin. 2014 Aug.

Abstract

Diabetes mellitus (DM) is a major risk factor for cardiovascular disease. Near-normal glycemic control does not reduce cardiovascular events. For many patients with 1- or 2-vessel coronary artery disease, there is little benefit from any revascularization procedure over optimal medical therapy. For multivessel coronary disease, randomized trials demonstrated the superiority of coronary artery bypass grafting over multivessel percutaneous coronary intervention in patients with treated DM. However, selection of the optimal myocardial revascularization strategy requires a multidisciplinary team approach ('heart team'). This review summarizes the current evidence regarding the effectiveness of various medical therapies and revascularization strategies in patients with DM.

Keywords: Blood glucose; Coronary disease; Diabetes mellitus; Hypoglycemic agents; Revascularization; Statins.

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Figures

Figure 1
Figure 1
Event rates for the composite endpoint of MI (nonfatal), stroke (nonfatal), and cardiovascular death in men (A) and women (B) stratified by age in relation to diabetes mellitus (DM) and a prior MI. From Schramm TK, Gislason GH, Kober L, et al. Diabetes patients requiring glucose-lowering therapy and nondiabetics with a prior myocardial infarction carry the same cardiovascular risk: a population study of 3.3 million people. Circulation. 2008;117:1945–1954; with permission.
Figure 2
Figure 2
Adjusted hazard ratios for all-cause mortality by HbA1c deciles in people given oral combination and insulin-based therapies. Vertical error bars show 95% CIs, horizontal bars show HbA1c range. Red circle=reference decile. *Truncated at lower quartile. †Truncated at upper quartile. Metformin plus sulphonylureas (A); and insulin-based regimens (B). From Currie CJ, Peters JR, Tynan A, et al. Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study. Lancet. 2010;375:481–489; with permission.
Figure 3
Figure 3
Management of hyperglycemia in patients with acute coronary syndromes. Adapted from Aronson D, Edelman ER. Role of CABG in the management of obstructive coronary arterial disease in patients with diabetes mellitus. Current opinion in pharmacology. 2012;12:134–141; with permission.
Figure 4
Figure 4
Cholesterol Treatment Trialists’ (CTT) Collaboration meta-analysis showing proportional effects of statins on major vascular events per mmol/L reduction in LDL cholesterol in participants presenting with or without diabetes. From Cholesterol Treatment Trialists C, Kearney PM, Blackwell L, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet. 2008;371:117–125; with permission.
Figure 5
Figure 5
Annual occurrence of freedom from angina in 1434 patients with angina at entry in BARI-2D. In the PCI stratum, the increase in freedom from angina was documented only at the first year of the follow-up. In the CABG stratum, the freedom from angina was increased during the 5-year follow-up. From Dagenais GR, Lu J, Faxon DP, et al. Effects of optimal medical treatment with or without coronary revascularization on angina and subsequent revascularizations in patients with type 2 diabetes mellitus and stable ischemic heart disease. Circulation. 2011;123:1492–1500; with permission.
Figure 6
Figure 6
Revascularization strategy in patients with DM and stable angina. * may be useful to exclude significant CAD
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References

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