Treatment of patients with ischemic heart disease and diabetes]

Around one third of patients with myocardial infarction are diabetic. More vigorous control of hyperglycemia, hyperlipidemia, and hypertension is likely to be of crucial importance for risk reduction. Although the effect of intensive glycemic control appears to be only minor in terms of prevention of cardiac events in diabetic patients, it has a major beneficial impact during acute myocardial infarction and after percutaneous transluminal coronary angioplasty. Lipid-lowering treatment is as effective in diabetic patients with coronary artery disease as in nondiabetic patients. In patients with coronary artery disease, there is strong evidence in favor of the use of b-blockers soon after myocardial infarction as well as in the long term. The metabolic treatment may also be considered as a rational approach for patients with stable angina. The long-term angiotensin converting enzyme inhibitor trials in patients with left ventricle dysfunction soon after myocardial infarction demonstrated a substantial benefit in the subgroup of diabetic patients. Current evidence leads us to recommend revascularization surgery as the first choice in diabetic patients. The management of risk factors should be more intensive in diabetic patients. In diabetic patients with coronary artery disease, most of the medical strategies are as effective as in nondiabetic patients.