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486 Cardio Diabetes Medicine 2017

Stable Ischaemic Heart Disease in Diabetics :

Medical Therapy vs Revascularization

Dr Gurpreet S Wander Dr Mridul Mahanta

MD (Medicine), DM (Cardiology) Dr Ravina Sharma
Professor and Head of Cardiology,
Dr Rohin Vinayak
Dayanand Medical College & Hospital,
Hero DMC Heart Institute, Ludhiana

Introduction 6. sympathovagal imbalance due to diabetic auto-
Stable ischemic heart disease (SIHD) is most com- nomic neuropathy,
monly caused by atheromatous plaque that obstructs 7. vascular effects of constitutive exposure to excess
or gradually narrows one or more of the epicardial insulin.
coronary arteries. However, other contributors, such
as endothelial dysfunction, microvascular disease, The clinical findings in patients with IHD are highly
and vasospasm, may also exist alone or in combi- variable ranging from asymptomatic to chest discom-
nation with coronary atherosclerosis and non athero- fort of variable magnitude and other features like
sclerotic causes, including congenital abnormalities heart failure, cardiac arrhythmias, and sudden death.
of the coronary vessels, myocardial bridging, coro- So management of SIHD depends on appropriate di-
nary arteritis in association with the systemic vascu- agnosis of coronary lesion, severity of disease and
litides, and radiation-induced CAD may be the domi- stratification of patient for need of revascularization.
nant cause of myocardial ischemia in some patients Appropriate work-up include detailed history and
1,2
clinical findings,noninvasive testing including resting
Compared with non diabetic persons, patients with ecg,stress ecg.stress imaging,CT coronary angiogra-
diabetes have a two- to fourfold increased risk for phy and invasive coronary angiography in patients
development with suspected SIHD who have survived sudden
death or serious ventricular arrhythmias or with high
of and death from CHD.Diabetes is associated with
an increased risk for MI. risk symptoms.

Coronary Heart Disease In The Patient With Management Strategy
Diabetes (Medical Therapy vs Revascularization)
Diabetic patients has associated traditional CHD risk
factors such as hypertension, dyslipidemia, and nu- Guideline directed medical therapy in patients with SIHD
merous other implicated mechanisms are involved in are oriented toward preventing death while maximizing
atherosclerotic disease progression. health and function. Coronary revascularization is
recommended when it has been shown to extend life.
The principal vascular perturbations linked to hyper-
glycemia include The guidelines identify five complementary
1. endothelial vasomotor dysfunction, strategies:
2. vascular effects of advanced glycation end prod- (1) Educate patients about the cause, manifestations,
ucts, and treatment options for IHD;
3. adverse effects of circulating free fatty acids, (2) Identify and treat conditions that contribute to,
worsen, or complicate IHD;
4. increased systemic inflammation,
(3) Modify risk factors for IHD;
5. the pernicious effects of hypoglycemia complicat-
ing diabetes therapy, (4) Use evidence-based pharmacologic treatments to

GCDC 2017