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Cardio Diabetes Medicine 2017 389

Role of Percutaneous Intervention in

Cardiovascular Diseases in Diabetes

Prof. R.S. HARIHARAN. MD DR. R. H. SUNDAR. MD, DNB (Cardiology),
Director, Director, Cardiology
Hariharan Institute of Diabetes &
Hariharan Diabetes& Heart care Hosp.Pvt.
Hariharan Diabetes & Heart Care Hospital (P) Ltd.,
Nanganallur, Chennai
Nanganallur, Chennai – 600 061.

Abstract

Cardiovascular diseases contribute to the increased that the commonest cause of death in diabetics is
morbidity and mortality in Diabetes. During the past cardiovascular in origin.
nearly two decades, primary prevention strategies 2. Diabetes involves the arterial tree from head to
and pharmacological approaches in the form of life toe irrespective of the vessel size. This involvement
style modification, cessation of smoking, physical results in more aggressive disease in diabetics than
exercise, statins, nitrates and aspirin have been their non-diabetic counterparts. Hence the need for
well addressed. The last decade is a witness to aggressive approach in the treatment of this epidem-
the emergence of percutaneous intervention as ic with newer technologies.
an effective complementary treatment to surgical
intervention in cardiovascular diseases in patients with 3. Percutaneous intervention has made rapid strides
or without diabetes. It is the purpose of this presentation in the past decade with the availability of modern
to highlight the role of percutaneous intervention in catheterization laboratories and newer hard- wares
cardiovascular diseases in diabetes. permitting one to treat these vascular diseases with-
out recourse to surgical intervention in a significant
Text number of patients.

1. Diabetes is well – known as a metabolic-cum- 4. Percutaneous intervention has two important roles:
vascular disease. Its vascular complications are both * Diagnosis of the obstructive arterial disease
micro-vascular and macrovascular. The micro-vascular
complications of retinopathy and nephropathy, which * Treatment of the obstructive arterial disease
are specific for Diabetes develop at a higher glucose 5. The role of percutaneous intervention in the diag-
threshold (viz 2 hour OGTT value of > 200mg%) than nosis of cardiovascular diseases in diabetics:
the macrovascular complications. The macrovascular
complications that occur also in non-diabetics, occur at (i) Coronary angiogram helps not only to delineate
a lower blood glucose threshold, (viz < 200mg%) than the Nature and extent of altherosclerotic coronary
the microvascular complications in diabetics. Further, artery disease, but also helps in the differential di-
their prevalence, incidence, distribution and severity agnosis of cardiac failure in diabetics. In diabetics
are more in diabetics compared to non- diabetics. Even presenting with features of cardiac failure, a
though one is normal coronary angiogram points to a diagnosis
of diabetic cardiomyopathy, while the presence of
concerned about the specific diabetic microangio- obstructive coronary artery disease points to a diag-
pathic complications of Diabetes, diabetics often nosis of ischaemic cardiomyopathy. It further guides
succumb to macroangiopathic complications. This in those with obstructive coronary artery disease as
was perhaps responsible for Miles Fisher to state to whether revascularisation is possible and, if so,
that Diabetes should be defined as “a disease of should it be by percutaneous angioplasty or coronary
premature cardiovascular death due to chronic hy- artery bypass surgery.
perglycaemia, and may also be associated with blind-
ness and renal failure.” This vididly describes the fact (ii) Likewise peripheral angiogram is extremely use-

Cardio Diabetes Medicine