Impact of treatment strategies on outcomes in patients with stable coronary artery disease and type 2 diabetes mellitus according to presenting angina severity: A pooled analysis of three federally-funded randomized trials

Mancini, G.B. John; Boden, William E.; Brooks, Maria M.; Vlachos, Helen; Chaitman, Bernard R.; Frye, Robert L.; Bittner, Vera; Hartigan, Pamela

doi:10.1016/j.atherosclerosis.2018.04.005

Cited by 13 publications

(5 citation statements)

References 29 publications

(7 reference statements)

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“…Несмотря на использование современных кардио-и вазопротекторных медикаментозных подходов, а также методов реваскуляризации, клинические проявления стенокардии присутствуют примерно у 1/3 пациентов со стабильной ИБС. Лица с СД2 и клиническими проявлениями стенокардии нередко имеют более распространенные и тяжелые коронарные поражения, чем пациенты без диабета, что может быть препятствием к реваскуляризации [43].…”

Section: антиангинальная терапияunclassified

“…У лиц с мультисосудистым стенозированием, поражением общего ствола левой КА, сложной коронарной анатомией -аортокоронарное шунтирование (АКШ) в сравнении с чрескожным коронарным вмешательством (ЧКВ) ассоциировано с уменьшением частоты отдаленных основных сердечно-сосудистых осложнений (РКИ BARI 2D, COURAGE, FREEDOM) при небольшом повышении риска инсультов в раннем периоде (частота инсультов в течение первых 30 дней после процедуры АКШ составляет 1,8 %, при ЧКВ -0,3 %). Более низкая частота сердечно-сосудистых осложнений после АКШ может быть связана с достигаемой при этом вмешательстве более значительной полнотой коронарной реваскуляризации [43][44][45][46].…”

Section: возможности реваскуляризацииunclassified

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Treatment of Patients Chronic Coronary Heart Disease and Type 2 Diabetes Mellitus

Shchukina

Приколота

Bagrij

et al. 2023

Arhivʺ vnutrennej mediciny

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The combination of chronic coronary heart disease and type 2 diabetes mellitus in a patient has high medical importance, because relevance of the problem increases every year. Modern requirements for the provision of high-quality medical care to patients with combined pathology require attentive assessment: we can’t deny the pathophysiological relationship of both diseases. Serious changes that occurred in the treatment tactics in relation to such patients require close attention of the medical community. Modern approaches of the therapy of this group of patients include treatment directions that improve the cardiovascular prognosis (lifestyle changes, anti-platelet therapy, antihypertensive therapy, statins and nonstatin lipid-lowering agents, which are indicated for patients who are difficult to tolerate statin treatment, glucose-lowering drugs), as well as careful management of stable angina syndrome (using of antianginal drugs, assessing the possibilities of revascularization). The therapeutic tactics of the new revision offers promising perspective regimens for taking antiplatelet therapy, lipid-lowering drugs. The new line of glucose-lowering drugs has high cardioprotective properties, reduces the intensity of vascular lesions (vasoprotection), and has renoprotective properties. The strategy of choosing glucose-lowering drugs has also undergone some changes: at the moment it is designated as «differentiated», which implies choosing a drug with the highest organoprotective properties. Achievement of target HbA1C levels in the range of 7.0-8.0 % is associated with the lowest patient mortality rate. In addition, to patients with type 2 diabetes mellitus, especially group with coronary heart disease, advised to minimize episodes of hypoglycemic conditions. Aim of this statement is to discuss in detail progressive approaches in the treatment of patients with chronic coronary heart disease and type 2 diabetes mellitus.

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Section: антиангинальная терапияunclassified

Section: возможности реваскуляризацииunclassified

Treatment of Patients Chronic Coronary Heart Disease and Type 2 Diabetes Mellitus

Shchukina

Приколота

Bagrij

et al. 2023

Arhivʺ vnutrennej mediciny

View full text Add to dashboard Cite

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“…Однако, несмотря на увеличивающиеся знания о патогенезе развития данной патологии и арсенал медикаментозных препаратов, примерно у 1/3 пациентов, находящихся на оптимальной консервативной терапии или перенёсших реваскуляризацию, сохраняются симптомы стенокардии [9]. Также нужно отметить, что у пациентов с СД наблюдаются более распространённые и тяжёлые поражения коронарных артерий (КА) по сравнению с пациентами без диабета, которые ставят вопросы перед мультидисциплинарной командой об адекватной тактике хирургического и медикаментозного лечения.…”

Section: сахарный диабет 2 типаunclassified

“…Также нужно отметить, что у пациентов с СД наблюдаются более распространённые и тяжёлые поражения коронарных артерий (КА) по сравнению с пациентами без диабета, которые ставят вопросы перед мультидисциплинарной командой об адекватной тактике хирургического и медикаментозного лечения. [9]. В связи с этим в 2022 г. Американская ассоциация сердца (AHA -American Heart Association) опубликовала документ, в котором были описаны принципы лечения пациентов со стабильной ИБС и СД 2 типа.…”

Section: сахарный диабет 2 типаunclassified

The choice of coronary revascularization method depending on comorbid pathology

Bazilevich,

Sidorov,

Kaplunovskaya

et al. 2023

jour

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Coronary heart disease plays a leading role in global mortality statistics. Despite the obvious progress in the development of new drug regimens, surgical treatment remains an important component. The high prevalence and complexity of treatment of patients with CHD and comorbid pathology, especially diabetes mellitus and chronic kidney disease, make researchers think about proper approaches to therapy of such patients. The decision to perform revascularization is made in consultation with all Heart Team members, taking into account the results of the invasive study, the presence of complaints in the patient and his "response" to drug therapy. Percutaneous coronary interventions (PCI) are still statistically more likely to result in restenosis and repeat revascularizations than open surgery. Hybrid myocardial revascularization is an alternative method combining the advantages of coronary artery bypass and PCI and reducing the risks of both procedures adverse complications. The choice of the optimal strategy of surgical treatment in patients with comorbid pathology requires special attention.

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“…Some symptom-based tools were reportedly used to categorise disease severity. [36][37][38] However, the majority of people with CHD are asymptomatic, which may limit the application of such tools to the wider population of patients with CHD in clinical practice. Other studies classified CHD severity either by the CHD onset type (myocardial infarction, unstable or stable angina categories), [39][40][41] or the number of hospitalisation events.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Assessing the severity of cardiovascular disease in 213 088 patients with coronary heart disease: a retrospective cohort study

et al. 2021

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ObjectiveMost current cardiovascular disease (CVD) risk stratification tools are for people without CVD, but very few are for prevalent CVD. In this study, we developed and validated a CVD severity score in people with coronary heart disease (CHD) and evaluated the association between severity and adverse outcomes.MethodsPrimary and secondary care data for 213 088 people with CHD in 398 practices in England between 2007 and 2017 were used. The cohort was randomly divided into training and validation datasets (80%/20%) for the severity model. Using 20 clinical severity indicators (each assigned a weight=1), baseline and longitudinal CVD severity scores were calculated as the sum of indicators. Adjusted Cox and competing-risk regression models were used to estimate risks for all-cause and cause-specific hospitalisation and mortality.ResultsMean age was 64.5±12.7 years, 46% women, 16% from deprived areas, baseline severity score 1.5±1.2, with higher scores indicating a higher burden of disease. In the training dataset, 138 510 (81%) patients were hospitalised at least once, and 39 944 (23%) patients died. Each 1-unit increase in baseline severity was associated with 41% (95% CI 37% to 45%, area under the receiver operating characteristics (AUROC) curve=0.79) risk for 1 year for all-cause mortality; 59% (95% CI 52% to 67%, AUROC=0.80) for cardiovascular (CV)/diabetes mortality; 27% (95% CI 26% to 28%) for any-cause hospitalisation and 37% (95% CI 36% to 38%) for CV/diabetes hospitalisation. Findings were consistent in the validation dataset.ConclusionsHigher CVD severity score is associated with higher risks for any-cause and cause-specific hospital admissions and mortality in people with CHD. Our reproducible score based on routinely collected data can help practitioners better prioritise management of people with CHD in primary care.

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Impact of treatment strategies on outcomes in patients with stable coronary artery disease and type 2 diabetes mellitus according to presenting angina severity: A pooled analysis of three federally-funded randomized trials

Abstract: Presenting angina severity did not influence the superiority of CABG + OMT with respect to 5-year rates of death/MI/stroke and need for post-randomization revascularization. Presenting angina severity minimally influenced relative benefits for angina control at 1 year.

Cited by 13 publications

References 29 publications

Treatment of Patients Chronic Coronary Heart Disease and Type 2 Diabetes Mellitus

Treatment of Patients Chronic Coronary Heart Disease and Type 2 Diabetes Mellitus

The choice of coronary revascularization method depending on comorbid pathology

Assessing the severity of cardiovascular disease in 213 088 patients with coronary heart disease: a retrospective cohort study

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