From the Research
Introduction to Diabetes Management with Ischemic Heart Disease (IHD)
Diabetes mellitus is closely associated with cardiovascular diseases, and ischemic heart disease is a major contributor to morbidity and mortality in diabetic patients 1, 2. The management of diabetes with IHD requires a comprehensive approach, including control of traditional risk factors, treatment of hyperglycemia, and prevention of cardiovascular events.
Treatment of Hyperglycemia
Treatment of hyperglycemia is crucial in reducing cardiovascular risk in diabetic patients 1. Metformin is recommended as the first-line treatment for newly diagnosed type 2 diabetes patients, with a target glycated hemoglobin value of less than 4.5% (IFCC methodology) 1. Intensified insulin regimen is the most suitable treatment approach for type 1 diabetes patients, also considering microvascular and macrovascular complication prevention 1.
Management of IHD in Diabetic Patients
The management of IHD in diabetic patients involves a range of strategies, including:
- Direct percutaneous coronary intervention (PCI) as the gold standard in the treatment of myocardial infarction (MI) in diabetic patients 1
- Drug-eluting stents, associated with fewer reocclusions, have also proved useful 1
- Surgical revascularization, preferably utilizing internal thoracic artery, is a suitable technique in patients without acute coronary syndrome indicated for an intervention 1, 3
- Conservative approach should be applied in less severely affected patients 1
Prevention of IHD in Diabetic Patients
Prevention of IHD in diabetic patients involves:
- Control of arterial hypertension
- Control of dyslipidemia
- Weight reduction
- Appropriate control of glycaemia to reduce the risk of hypoglycemia in high-risk patients with longer duration of diabetes and known cardiovascular disease 1
Antithrombotic Therapy
The choice of antithrombotic therapy in patients with coronary heart disease and type 2 diabetes mellitus is crucial in reducing the risk of death 4. A combination of rivaroxaban 2.5 mg twice a day and acetylsalicylic acid 100 mg/day is recommended for patients with stable IHD 4.
Cardiac Metabolic Agents
Cardiac metabolic agents, such as trimetazidine and glucose-insulin-potassium (GIK), may represent a new approach to the management of IHD in diabetic patients, by correcting the alterations to cardiac metabolism associated with diabetes mellitus 5.
Conclusion
The management of diabetes with IHD requires a comprehensive approach, including control of traditional risk factors, treatment of hyperglycemia, and prevention of cardiovascular events. A range of strategies, including PCI, drug-eluting stents, surgical revascularization, and antithrombotic therapy, are available for the management of IHD in diabetic patients. Cardiac metabolic agents may also play a role in the management of IHD in diabetic patients.