Chronic stable angina treatment diabetes control

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S.; Aysha Anwar, M.B.B.S[2]


Diabetes is one of the major modifiable risk factors for coronary artery disease. Maintaining a good glycemic control has been demonstrated to delay the disease progression in patients with impaired glycemic control and further prevent microvascular complications.[1][2][3] In type 1 diabetics, appropriate insulin therapy and concomitant dietary modification may be required. However, in patients with type 2 diabetes, a multi-factorial intervention involving increased physical activity, weight reduction, dietary modification and/or drug therapy has shown to reduce the risk of overall cardiovascular and microvascular events by approximately 50%.[4][5]

Diabetes Control

Supportive Trial Data

  • The PROactive study, a prospective, randomized control trial of 5,238 patients with type 2 diabetes and evidence of macrovascular disease, assed the efficacy of pioglitazone on macrovascular morbidity and mortality in high-risk patients with type 2 diabetes. Researchers reported a significant reduction in the incidence of composite primary endpoint that included death or non-fatal MI. Findings also suggested that the addition of pioglitazone to other hypoglycemic agents provided better overall clinical outcomes.[6]
  • The Steno-2 study, a randomized parallel trial of 160 patients who either received conventional treatment based on national guidelines or intensive treatment involving behavior modification and pharmacologic therapy, assessed the effect of multi-factorial intervention in patients with type 2 diabetes and microalbuminuria. Researchers demonstrated a significant reduction in the risk of cardiovascular disease (hazard ratio: 0.47; 95% CI, 0.24, 0.73) and nephropathy (hazard ratio: 0.39; 95% CI, 0.17, 0.87). It was reported that when a target-driven, long-term, multi-factorial intervention was applied to patients with type 2 diabetes and microalbuminuria the risk of cardiovascular disease could be reduced by approximately 50%.[5]

2012 Chronic Angina Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)[7]

Diabetes Management (DO NOT EDIT)[7]

Class IIa
"1. Diabetes management should include lifestyle and pharmacotherapy measures to achieve a near-normal HbA1c. (Level of Evidence: B) "
"2. A goal hemoglobin A1c between 7% and 9% is reasonable for certain patients according to age, history of hypoglycemia, presence of microvascular or macrovascular complications, or presence of coexisting medical conditions. (Level of Evidence: C) "
Class IIb
"1. Initiation of pharmacotherapy interventions to achieve target hemoglobin A1c might be reasonable. (Level of Evidence: A) "
Class III
"1. Therapy with rosiglitazone should not be initiated in patients with SIHD. (Level of Evidence: B) "


  1. European Society of Hypertension-European Society of Cardiology Guidelines Committee (2003) 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 21 (6):1011-53. DOI:10.1097/01.hjh.0000059051.65882.32 PMID: 12777938
  2. American Diabetes Association (2003) Standards of medical care for patients with diabetes mellitus. Diabetes Care 26 Suppl 1 ():S33-50. PMID: 12502618
  3. Inzucchi SE, Amatruda JM (2003) Lipid management in patients with diabetes: translating guidelines into action. Diabetes Care 26 (4):1309-11. PMID: 12663615
  4. De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J et al. (2003) European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J 24 (17):1601-10. PMID: 12964575
  5. 5.0 5.1 Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O (2003) Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 348 (5):383-93. DOI:10.1056/NEJMoa021778 PMID: 12556541
  6. Dormandy JA, Charbonnel B, Eckland DJ, Erdmann E, Massi-Benedetti M, Moules IK et al. (2005) Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet 366 (9493):1279-89. DOI:10.1016/S0140-6736(05)67528-9 PMID: 16214598
  7. 7.0 7.1 Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP; et al. (2012). "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 126 (25): 3097–137. doi:10.1161/CIR.0b013e3182776f83. PMID 23166210.

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