Complications of diabetes: angina

摘要

For the patient with diabetes, accelerated artherosclerosis is the major determinant of risk. Severe coronary artery disease is often well established in middle age and, unlike the non-diabetic populations, female gender confers little or no protection. Myocardial infarction, the usual cause of death in diabetes, commonly occurs before the age of 50. Coronary artery disease in patients with diabetes is characteristically diffuse and severe involving not only proximal epicardial segments but also extending into the distal segments. Ischaemia, therefore, tends to be severe and is exacerbated by vasomotor dysfunction through endothelium-dependent and endothelium-independent mechanisms. Thus flow-mediated dilation is nearly always impaired in diabetes and flow responses to cold stress, which are sympathetically mediated, are also reduced, often in association with autonomic