ОсложненияComplications ышедшие в 2013 г. «Рекомендации по диа-бету, предиабету и сердечно-сосудистым за-болеваниям EASD/ESC» [1] подчеркивают роль доказательной медицины в снижении смертности от сердечно-сосудистых заболеваний (ССЗ) у паци-ентов с нарушениями углеводного обмена (УО). В РФ, где на 01.01.2014 года зарегистрировано 3 964 889 паци-ентов с диагнозом «Сахарный диабет» (СД) [2], снижение кардиоваскулярной смертности среди лиц с нарушени-ями УО крайне актуально [3]. Острый инфаркт миокарда (ОИМ) -одна из ведущих причин смерти от ССЗ и самая частая причина внезапной сердечной смерти (ВСС) в РФ. Он ежегодно развивается у 0,2-0,6% мужчин в воз-расте от 40 до 59 лет и у 1,7% мужчин от 60 до 64 лет. Жен-щины в молодом и среднем возрасте болеют в 2-2,5 раза реже мужчин, что связано с более поздним развитием у них атеросклероза [4]. На сегодняшний день ССЗ явля-ются главной причиной смерти у пациентов с сахарным диабетом 2 типа (СД2) во всем мире. С 1945 г. число боль-ных СД в мире удваивалось каждые 20 лет [5], достигнув к 2015 г. 387 миллионов человек [6]. Летальность от ССЗ у больных СД2 в 2-3 раза выше, чем в популяции [5].
Cerebrovascular accident (CA) is a nowadays widely spread, highly incapacitating and often lethal event that poses a prominent clini- cal problem. Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) ? an ?epidemic? of the century, ? are known to be its primary risk factors. Hyperglycemia promotes CA risks by induction of protein glycosylation, elevation of blood plasma atherogenic potential, activation of coagulation system with higher risk for thrombosis and disturbance of microcirculation on tissue and organ lev- els. Influence of hyperglycemia on severity and extent of neurologic damage is still under evaluation. Development of macroangiopathy is thought to be associated with media calcification, distal polyneuropathy and renal disorders, all of which are cardiovascular risk factors. Application of so-called metabolic drugs resulted in certain disillusionment, as these agents failed to prove their efficacy during clinical trials. Incidence of pulmonary edema in patients with ischemic CA and T2DM is important as it dictates the necessity for use of loop diuretics. Incidence and severity of heart failure and its correlation with degree of glycemic disorders, incidence of pulmonary em- bolism, as well as tactics of management and prognosis in patients with ischemic CA and T2DM, remains a relevant research problem.
This review addresses clinical picture of acute coronary syndrome (ACS) in patients with type 2 diabetes mellitus (T2DM), the corre- sponding epidemiology data, morphological characteristics and prognosis. ACS in patients with T2DM features fulminant development, and its high lethality is due to chronic ischemic alterations in myocardium (the so-called ?metabolic ischemia?), as well as concomitant microangiopathy. It is more common for patients with T2DM to develop such complications of ACS as cardiogenic shock, acute left ventricular failure and arrhythmia that result in increased lethality during early hours of hospital admission when myocardial necrosis is yet to occur. Percutaneous translumenal intervention is by far the most effective method of ACS management in patients with T2DM. Whenever it is not available, a thrombolytic approach is indicated.
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