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Treatment of coronary insufficiency in diabetics. Part 3: chronic coronary insufficiency



Treatment of coronary insufficiency in diabetics. Part 3: chronic coronary insufficiency



Annales de Cardiologie et d'Angeiologie 48(3): 209-220



The drug treatment of chronic coronary insufficiency in diabetic patients is now well defined. Platelet antiaggregants, especially aspirin, must be prescribed in the long-term or even indefinitely. Other drugs (beta-blockers, calcium channel blockers, nitrates, etc.) can be used in the same way as in the absence of diabetes. Angioplasty gives immediate favourable results in diabetics, very similar to those obtained in the absence of diabetes. In contrast, the longer term prognosis is less favourable, as the mortability, myocardial infarction, restenosis and bypass graft rates are significantly higher. First-line stenting lowers the restenosis rate to a level comparable to that observed in non-diabetics. However, instrumental revascularization is less complete than surgical revascularization and the number of redilatations and/or secondary bypass grafts remains high. The indications, mortality and early complications of coronary surgery are now identical to those observed in the absence of diabetes. Its long-term results are significantly more favourable than those of medical treatment or even angioplasty, although this issue is still controversial. The improved prognosis observed in operated diabetic coronary patients is due to the more frequent use of arterial bypass grafts. The maintenance of blood glucose control and correction of the frequently associated cardiovascular risk factors (obesity, sedentary lifestyle, smoking, HT, dyslipidaemia) increase the efficacy of treatment of coronary insufficiency in diabetic patients. This goal can only be achieved by permanent, unfailing collaboration between cardiologists and diabetologists.

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