Coronary Artery Disease and Type 2 Diabetes Mellitus

Abstract

Type 2 diabetes mellitus (T2DM) is a major risk factor of coronary artery diseases (CAD). Clinical outcomes in CAD with T2DM are poor despite improvement in medications and intervention devices. Coronary artery bypass grafting (CABG) is superior to percutaneous coronary intervention (PCI) in treating diabetic patients with multivessel coronary artery diseases (MVD). However, selecting a revascularization strategy should depend not only on the lesion complexity but also on the patient's background and comorbidities. In addition, comprehensive risk management with medical and non-pharmacological therapies is important, as is confirmation of whether risk managements are appropriately achieved. Recently, novel anti-diabetic drugs have been demonstrated to have effectiveness in reducing cardiovascular events, which was independent of their glucose-lowering effect. Furthermore, non-pharmacological interventions using exercise and diet during the earlier stages of abnormal glucose metabolism might be beneficial in preventing the development or progression of T2DM and reducing the incidence of cardiovascular events.

Clinical Implications of Baroreflex Sensitivity in Type 2 Diabetes

“…Recently, the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose (EMPA-REG OUTCOME) Study and the Canagliflozin Cardiovascular Assessment Study (CANVAS) showed that sodium-glucose cotransporter 2 (SGLT-2) inhibitors decreased the incidence of CV events in the early stage of T2DM. [70][71][72] SGLT-2 inhibitors comprise a new class of antidiabetic drugs that lower blood glucose levels by inhibiting SGLT-2 in the renal proximal tubule and increase urinary glucose excretion. Compensatory enhancement of sympathetic nerve activity was of concern due to a significant diuretic effect of SGLT-2 inhibitors.…”

Additional Value of Early Repolarization Pattern in Prediction of Obstructive Coronary Artery Disease as Assessed by Coronary Angiography

“…The risk magnitude appears to be at least as strong as those reported for wellestablished major risk factors. 20,21) In real-world clinical settings, low-risk and intermediate-risk patients with CAD might be more easily subjected to misdiagnosis than highrisk patients. In addition, patients with multi-vessel CAD had a greater chance of developing acute myocardial infarction and sudden cardiac death than those with singlevessel CAD, and the early detection of this patient group could be of greater importance.…”

Multivessel Coronary Artery Disease in Diabetes Mellitus Patients

“…One of the major risk factors for cardiovascular disease is diabetes mellitus, even near controlled blood sugar doesn't seem to reduce these cardiovascular events. This is true for type 2 diabetes mellitus, which carries a very poor outcome in cases of coronary artery disease despite the presence of different modalities of treatments like percutaneous coronary intervention, and coronary artery bypass graft surgery [3], [4]. Blood supply of the heart is composed of right and left coronary arteries arising from right and left coronary sinuses respectively, the RCA gives small branches and continue posteriorly in the inter ventricular groove, or might bifurcate to be posterior descending artery (PDA) and posterior-lateral vessel (PLV).…”