Coronary heart disease in diabetes - clinical peculiarities

Abstract

Ischaemic heart disease associated with premature coronary atherosclerosis is the most frequent complication of diabetes mellitus. The combination of diabetes and ischaemic heart disease causes a 2–3-fold increase of mortality risk among men and 3–5-fold among women. In patients with diabetes type 2 atherosclerotic complications, including coronary heart disease are present at the time of diabetes detection. The development of ischaemic heart disease is associated both with classical coronary risk factors and diabetes-related specific factors, which markedly increases global risk. Typical risk factors leading to atherosclerosis and cardiovascular diseases in type 2 diabetes include central obesity, insulin resistance and hyperinsulinemia, coagulation and fibrinolysis disorders, dyslipidemia. Hyperglycemia is also a coronary risk factor. Microalbuminuria is a characteristic atherosclerotic risk factor in diabetes.Metabolic coronary risk factors form a metabolic syndrome recently defined by the WHO. In patients with diabetes type 1 diabetic nephropathy is a major cause of increased morbidity and mortality due to cardiovascular diseases. Coronary atherosclerosis in diabetes is more extensive and progresses rapidly. Coronary heart diseases in diabetics is frequently atypical and usually associated with heart failure. Coronary heart disease in diabetics is treated with the same agents and invasive procedures as in non-diabetics. As the risk of coronary heart diseases and cardiovascular mortality is higher in diabetics such patients should undergo early and aggressive diagnostic procedures, and comprehensive prevention and therapy.