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Current Atherosclerosis Reports

, Volume 10, Issue 2, pp 106–116 | Cite as

Prevention and noninvasive management of coronary atherosclerosis in patients with diabetes

  • Martial G. BourassaEmail author
  • Colin Berry
Article

Abstract

Diabetes mellitus (DM) is a worldwide epidemic. Its prevalence is rapidly increasing in both developing and developed countries. Coronary heart disease (CHD) is highly prevalent and is the major cause of morbidity and mortality in patients with diabetes. Individuals with prediabetes states, with or without known CHD, should undergo lifestyle modifications aimed at preventing DM. In patients with CHD and DM, routine use of aspirin and an angiotensin-converting enzyme inhibitor, along with strict glycemic, blood pressure, and lipid control, is strongly recommended. Intense insulin therapy may be needed for glycemic control, and high-dose statin therapy may be needed for lipid control. For blood pressure control, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are considered first-line therapy. Noncompliance with medications and/or lifestyle measures and underprescription of evidence-based therapies remain important unsolved problems.

Keywords

Metformin Glycemic Control Rosiglitazone Pioglitazone Ramipril 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References and Recommended Reading

  1. 1.
    Berry C, Tardif JC, Bourassa MG: Coronary heart disease in patients with diabetes. Part I: recent advances in prevention and non-invasive management. J Am Coll Cardiol 2007, 49:631–642.PubMedCrossRefGoogle Scholar
  2. 2.
    American Diabetes Association: Standards of medical care in diabetes-2006. Diabetes Care 2006, 29(Suppl 1):S4–S42.Google Scholar
  3. 3.
    Lichtenstein AH, Appel LJ, Brands M, et al.: Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 2006, 114:82–96.PubMedCrossRefGoogle Scholar
  4. 4.
    Buse JB, Ginsberg HN, Bakris GL, et al.: Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation 2007, 115:114–126.PubMedCrossRefGoogle Scholar
  5. 5.
    Nathan DM, Buse JB, Davidson MB, et al.: Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2006, 29:1963–1972.PubMedCrossRefGoogle Scholar
  6. 6.
    Poirier P, Giles TD, Bray GA, et al.: Obesity and cardiovascular disease: pathophysiology, evaluation and effect of weight loss: an update of the 1997 American Heart Association scientific statement on obesity and heart disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 2006, 113:898–918.PubMedCrossRefGoogle Scholar
  7. 7.
    Kavey RE, Allada V, Daniels SR, et al.: Cardiovascular risk reduction in high-risk pediatric patients. A scientific statement from the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood pressure Research, cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research. Circulation 2006, 114:2710–2738.PubMedCrossRefGoogle Scholar
  8. 8.
    Sigal RJ, Kenny GP, Wasserman DH, et al.: Physical activity/exercise and type 2 diabetes. A consensus statement from the American Diabetes Association. Diabetes Care 2006, 29:1433–1438.PubMedCrossRefGoogle Scholar
  9. 9.
    Lipscombe LL, Hux JE: Trends in diabetes prevalence, incidence, and mortality in Ontario, Canada 1995–2005: a population-based study. Lancet 2007, 369:750–756.PubMedCrossRefGoogle Scholar
  10. 10.
    Jones LR, Wilson CI, Wadden TA: Lifestyle modification in the treatment of obesity: an educational challenge and opportunity. Clin Pharmacol Ther 2007, 81:776–779.PubMedCrossRefGoogle Scholar
  11. 11.
    Eckel RH, Kahn R, Robertson RM, Rizza RA: Preventing cardiovascular disease and diabetes. A call to action from the American Diabetes Association and the American Heart Association. Diabetes Care 2006, 29:1697–1699.PubMedCrossRefGoogle Scholar
  12. 12.
    Lorenzo C, Williams K, Hunt KJ, Haffner SM: The National Cholesterol Education Program-Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes. Diabetes Care 2007, 30:8–13.PubMedCrossRefGoogle Scholar
  13. 13.
    Booth GL, Kapral MK, Fung K, Tu JV: Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. Lancet 2006, 368:29–36.PubMedCrossRefGoogle Scholar
  14. 14.
    Knopp RH, D’Emden M, Smilde JG, Pocock SJ, on behalf of the ASPEN Study Group: Efficacy and safety of atorvastatin in the prevention of cardiovascular end points in subjects with type 2 diabetes. The Atorvastatin Study for Prevention of coronary heart disease Endpoints in Non-insulin dependent diabetes mellitus (ASPEN). Diabetes Care 2006, 29:1478–1485.PubMedCrossRefGoogle Scholar
  15. 15.
    Donahoe SM, Stewart GC, McCabe CH, et al.: Diabetes and mortality following acute coronary syndromes. JAMA 2007, 298:765–775.PubMedCrossRefGoogle Scholar
  16. 16.
    Wang J, Ruotsalainen S, Moilanen L, et al.: The metabolic syndrome predicts cardiovascular mortality: a 13-year follow-up study in elderly non-diabetic Finns. Eur Heart J 2007, 28:857–864.PubMedCrossRefGoogle Scholar
  17. 17.
    Mozaffarian D, Marfisi RM, Levantesi G, et al.: Incidence of new-onset diabetes and impaired fasting glucose in patients with recent myocardial infarction and the effect of clinical and lifestyle risk factors. Lancet 2007, 370:667–675.PubMedCrossRefGoogle Scholar
  18. 18.
    The DREAM Trial Investigators: Effect of ramipril on the incidence of diabetes. N Engl J Med 2006, 355:1551–1562.CrossRefGoogle Scholar
  19. 19.
    The DREAM Trial Investigators: Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomized controlled trial. Lancet 2006, 368:1096–1105.CrossRefGoogle Scholar
  20. 20.
    Ratner RE, for the Diabetes Prevention Program Research Group: An update on the diabetes prevention program. Endocr Pract 2006, 12:20–24.PubMedGoogle Scholar
  21. 21.
    Chiasson JL: Acarbose for the prevention of diabetes, hypertension, and cardiovascular disease in subjects with impaired glucose tolerance: the Study to Prevent Non-Insulin-Dependent Diabetes Mellitus (STOP-NIDDM) Trial. Endocr Pract 2006, 12(Suppl 1):25–30.PubMedGoogle Scholar
  22. 22.
    Aronne LJ: Therapeutic options for modifying cardiometabolic risk factors. Am J Med 2007, 120:S26–S34.PubMedCrossRefGoogle Scholar
  23. 23.
    Pi-Sunyer FX, Aronne LJ, Heshmati HM, et al.; RIO-North America Study Group: Effect of rimonabant, a cannabinoid-1 receptor blocker, on weight and cardiometabolic risk factors in overweight or obese patients: RIO-North America: a randomized controlled trial. JAMA 2006, 295:761–775.PubMedCrossRefGoogle Scholar
  24. 24.
    Zinman B, Harris SB, Gerstein HC, et al.: Preventing type 2 diabetes using combination therapy: design and methods of the CAnadian Normoglycaemia Outcomes Evaluation (CANOE) trial. Diabetes Obes Metab 2006, 8:531–537.PubMedCrossRefGoogle Scholar
  25. 25.
    Wexler DJ, Meigs JB, Cagliero E, et al.: Prevalence of hyper-and hypoglycemia among inpatients with diabetes: anational survey of 44 U.S. hospitals. Diabetes Care 2007, 30:367–369.PubMedCrossRefGoogle Scholar
  26. 26.
    Vasudevan AR, Burns A, Fonseca VA: The effectiveness of intensive glycemic control for the prevention of vascular complications in diabetes mellitus. Treat Endocrinol 2006, 5:273–286.PubMedCrossRefGoogle Scholar
  27. 27.
    The Look AHEAD Research Group: Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes. One-year results of the Look AHEAD trial. Diabetes Care 2007, 30:1374–1383.CrossRefGoogle Scholar
  28. 28.
    Scheen AJ, Finer N, Hollander P, et al.; for the RIO-Diabetes Study Group: Efficacy and tolerability of rimonabant in overweight or obese patients with type 2 diabetes: a randomized controlled study. Lancet 2006, 368:1660–1672.PubMedCrossRefGoogle Scholar
  29. 29.
    Mazzone T, Meyer PM, Feinstein SB, et al.: Effect of pioglitazone compared with glimepiride on carotid intima-media thickness in type 2 diabetes. JAMA 2006, 296:2572–2581.PubMedCrossRefGoogle Scholar
  30. 30.
    Khan SE, Haffner SM, Heise MA, et al.; for the ADOPT Study Group: Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med 2006, 355:2427–2443.CrossRefGoogle Scholar
  31. 31.
    Home PD, Pocock SJ, Beck-Nielsen H, et al.: Rosiglitazone evaluated for cardiovascular outcomes-an interim analysis. N Engl J Med 2007, 357:28–38.PubMedCrossRefGoogle Scholar
  32. 32.
    Buse JB, Bigger JT, Byington RP, et al.; ACCORD Study Group: Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: design and methods. Am J Cardiol 2007, 99(12A):21i–33i.CrossRefGoogle Scholar
  33. 33.
    Magee MF, Isley WL; BARI 2D Trial Investigators: Rationale, design, and methods for glycemic control in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. Am J Cardiol 2006, 97:20G–30G.PubMedCrossRefGoogle Scholar
  34. 34.
    Nissen SE, Wolski K: Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med 2007, 356:2457–2471.PubMedCrossRefGoogle Scholar
  35. 35.
    Lincoff AM, Wolski K, Nicholls SJ, Nissen SE: Pioglitazone and risk of cardiovascular events in patients with type 2 diabetes mellitus. A meta-analysis of randomized trials. JAMA 2007, 298:1180–1188.PubMedCrossRefGoogle Scholar
  36. 36.
    Singh S, Loke YK, Furberg CD: Long-term risk of cardiovascular events with rosiglitazone. A meta-analysis. JAMA 2007, 298:1189–1195.PubMedCrossRefGoogle Scholar
  37. 37.
    Kendall C, Wooltorton E: Rosiglitazone (Avandia) and macular edema. Can Med Assoc J 2006, 174:623.CrossRefGoogle Scholar
  38. 38.
    Shepherd J, Barter P, Carmena R, et al.; for the Treating to New Targets Investigators: Effect of lowering LDL cholesterol substantially below currently recommended levels in patients with coronary heart disease and diabetes: the Treating to New Targets study. Diabetes Care 2006, 29:1220–1226.PubMedCrossRefGoogle Scholar
  39. 39.
    Nissen SE, Tardif JC, Nicholls SJ, et al.; ILLUSTRATE Investigators: Effect of torcetrapib on the progression of coronary atherosclerosis. N Engl J Med 2007, 356:1304–1316.PubMedCrossRefGoogle Scholar
  40. 40.
    Ginsberg HN, Bonds DE, Lovato LC, et al.; for the ACCORD Study Group: Evolution of the lipid trial protocol of the Action to Control Cardiovascual Risk in Diabetes (ACCORD) trial. Am J Cardiol 2007, 99(Suppl):56i–67i.PubMedCrossRefGoogle Scholar
  41. 41.
    Lachin JM, Christophi CA, Edelstein SL, et al.: Factors associated with diabetes onset during metformin versus placebo therapy in the diabetes prevention program. Diabetes 2007, 56:1153–1159.PubMedCrossRefGoogle Scholar
  42. 42.
    Poirier P, Després JP, Bertrand OF: Identifying which patients with diabetes should be tested for the presence of coronary artery disease-the importance of baseline electrocardiogram and exercise testing. Can J Cardiol 2006, 22:9A–15A.PubMedGoogle Scholar
  43. 43.
    Albers AR, Krichavsky MZ, Balady GJ: Stress testing in patients with diabetes mellitus. Diagnostic and prognostic value. Circulation 2006, 113:583–592.PubMedCrossRefGoogle Scholar
  44. 44.
    Patel A; ADVANCE Collaborative Group: Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomized controlled trial. Lancet 2007, 370:829–840.PubMedCrossRefGoogle Scholar
  45. 45.
    Anselmino M, Bartnik M, Malmberg K, Ryden L, on behalf of the Euro Heart Survey Investigators: Management of coronary artery disease in patients with and without diabetes mellitus. Acute management reasonable but secondary prevention unacceptably poor: a report from the Euro Heart Survey on Diabetes and the Heart. Eur J Cardiovasc Prev Rehabil 2007, 14:28–36.PubMedCrossRefGoogle Scholar
  46. 46.
    Hicks PC, Westfall JM, Van Vorst RF, et al.: Action or inaction? Decision making in patients with diabetes and elevated blood pressure in primary care. Diabetes Care 2006, 29:2580–2585.PubMedCrossRefGoogle Scholar
  47. 47.
    Spann SJ, Nutting PA, Galliher JM, et al.: Management of type 2 diabetes in the primary care setting: a practice-based research network study. Ann Fam Med 2006, 4:23–31.PubMedCrossRefGoogle Scholar
  48. 48.
    Cushman WC, Basile J: Achieving blood pressure goals: why aren’t we? J Clin Hypertens 2006, 8:865–872.CrossRefGoogle Scholar
  49. 49.
    Yan AT, Yan RT, Tan M, et al.; for the Vascular Protection (VP) and Guidelines Oriented Approach to Lipid Lowering (GOALL) Registries Investigators: Contemporary management of dyslipidemia in high-risk patients: targets still not met. Am J Med 2006, 119:676–683.PubMedCrossRefGoogle Scholar
  50. 50.
    Bhatt DL, Steg PG, Ohman EM, et al.: International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006, 295:180–189.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.Department of Medicine, Montreal Heart InstituteUniversité de MontréalMontrealCanada

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