Treating myocardial ischemia in diabetics : drugs , surgery , and stents

Diabetes mellitus (T2DM) is a chronic, progressively worsening disease associated with a variety of complications. Management of T2DM should take into account that coronary artery disease may be silent for many years in diabetic patients, and so both primary and secondary prevention must be a priority in the treatment of such disease. The management of chronic stable angina in patients with T2DM follows the same principles as those for patients without diabetes mellitus—controlling ischemic symptoms and reducing ischemic burden. To this end, treatment consists of medications combined with lifestyle modifications, the three main interventions being smoking cessation, regular moderate aerobic exercise, and correct nutrition. This article focuses on antianginal/anti-ischemic medications and myocardial revascularization procedures. Guidelines suggest use of β-blockers or calcium antagonists as first-line therapy for stable angina in T2DM. Nicorandil, ranolazine, and trimetazidine should be considered when first-line medications cannot be used or are insufficient. On the basis of findings from BARI-2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes), FREEDOM (Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal Management of multivessel disease), and recent meta-analyses, coronary artery bypass grafting is considered the preferred coronary revascularization procedure in patients with T2DM and multivessel disease when reduction in clinical events is the main goal of treatment. L Heart Metab. 2017;73:13-17