Coronary Heart Disease

Coronary Heart Disease is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

  • Coronary heart disease (CHD), stroke, and peripheral vascular disease (PVD) are responsible for 80% of deaths in persons with diabetes1,2 (see Chapter 4, Ischemic Heart Disease).
  • Coronary artery disease (CAD) occurs at a younger age and may have atypical clinical presentations in patients with diabetes.2
    • MI carries a worse prognosis, and angioplasty gives less satisfactory results in patients with diabetes.
    • Persons with diabetes have an increased risk of ischemic and nonischemic heart failure (HF) and sudden death.3

Risk Factors

Risk factors for macrovascular disease that are common in persons with diabetes include insulin resistance, hyperglycemia, albuminuria, hypertension, hyperlipidemia, cigarette smoking, and obesity.

Prevention

  • CV risk factors should be assessed at least annually and treated aggressively (see treatment goals in the following text). Stress tests, with or without imaging, should be reserved for those with typical or atypical chest pain or those with abnormalities on ECG.4
  • Screening asymptomatic persons with cardiac stress test has not been shown to reduce mortality or events in asymptomatic patients with T2DM.4
  • Aspirin 81–325 mg/d has proven beneficial in secondary prevention of MI or stroke in patients with diabetes and may be considered for persons over age 40 years with diabetes.

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General Principles

  • Coronary heart disease (CHD), stroke, and peripheral vascular disease (PVD) are responsible for 80% of deaths in persons with diabetes1,2 (see Chapter 4, Ischemic Heart Disease).
  • Coronary artery disease (CAD) occurs at a younger age and may have atypical clinical presentations in patients with diabetes.2
    • MI carries a worse prognosis, and angioplasty gives less satisfactory results in patients with diabetes.
    • Persons with diabetes have an increased risk of ischemic and nonischemic heart failure (HF) and sudden death.3

Risk Factors

Risk factors for macrovascular disease that are common in persons with diabetes include insulin resistance, hyperglycemia, albuminuria, hypertension, hyperlipidemia, cigarette smoking, and obesity.

Prevention

  • CV risk factors should be assessed at least annually and treated aggressively (see treatment goals in the following text). Stress tests, with or without imaging, should be reserved for those with typical or atypical chest pain or those with abnormalities on ECG.4
  • Screening asymptomatic persons with cardiac stress test has not been shown to reduce mortality or events in asymptomatic patients with T2DM.4
  • Aspirin 81–325 mg/d has proven beneficial in secondary prevention of MI or stroke in patients with diabetes and may be considered for persons over age 40 years with diabetes.

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