Percutaneous coronary intervention in high risk diabetic population: clinical management.

摘要

Diabetes mellitus is a growing health problem, with its prevalence expected to rise dramatically in the Westernized societies. [1] The major threat relating with this disease is the markedly increased risk of coronary and peripheral artery diseases. [2] In fact, the Framingham Heart study reported that the risk of a first cardiovascular event or of a following event in a patient with known coronary artery disease was from two to five folds higher in the DM subjects.[3] Given then high risk profile, the finding that 75% of these subjects die for cardiovascular disease is indeed not suprising.[4] In the attempt of explaining this excess of mortality the synergism of hyperglycemia with the other classical cardiovascular risk factors, such as obesity, hypertension, dyslipideruia, and smoking has been considered, [5] advocating a multifactorial approach for the management of DM patients. The American Diabetes Association recommendations regarding an aggressive treatment program of all cardiovascular risk factors [6] have been in fact confirmed by major clinical trials. The United Kingdom Prospective Diabetes Study [7] and the Steno 2 trial, [8] evaluating the impact of multiple schemes of DM treatment on the occurrence of DM micro and macro-vascular complications, strongly supported the efficacy of an intensive management to modify short and long term prognosis of DM patients. Furthermore, besides the relevance of achieving the recommended targets of fasting plasma glycemia, blood pressure, and cholesterol profiles, the studies of De Berardis et al. [9] and of Hag et al. [10] emphasized the impact of the assiduity of cardiovascular risk factors monitoring during the patients follow-up. In fact, only and optimal clinical management demonstrated to reduce the incidence of further cardiovascular events in DM patients. Previous prospective or observational studies [11] and registries have demonstrated that these patients consistently received an inadequate treatment reporting a universally confirmed more dismal prognosis in respect to the non-DM population. Besides the under treatment with the available clinical tools, the modem therapeutic interventions may also exert a lower efficacy in the DM patients compared to the general population due to the higher extent of their coronary disease progression upon native vessel. [12]