Angina is common in the adult diabetic population. The symptoms of diabetic angina are commonly atypical, and often absent (silent ischaemia). Conventional anti-anginal drugs are effective in diabetic patients, but referral for angiography and consideration of percutaneous or surgical revascularisation is necessary if symptoms persist. Secondary prevention strategies are reviewed within the context of medical and surgical treatment options.
Di Carli MF, Bianco-Batlles D., Landa ME et al. Effects of autonomic neuropathy on coronary blood flow in patients with diabetes mellitus. Circulation1999;100:813-9.
2.
Storstein L. , Jervell J.Response to bicycle exercise testing in long-standing juvenile diabetes. Acta Med Scand1979;205:227-30.
3.
Hilsted J., Galbo H., Christensen NJImpaired cardiovascular responses to graded exercise in diabetic autonomic neuropathy. Diabetes1979;28: 313-9.
4.
Hypertension in Diabetes Study Group, HDS. 1: Prevalence of hypertension in newly presenting type 2 diabetic patients and the association with risk factors for cardiovascular and diabetic complications . J Hypertens1993;11:309-17.
5.
United Kingdom ProspectiveDiabetes Study(UKPDS) Group. Risk factors for coronary artery disease in non-insulin dependent diabetes (UKPDS 23). BMJ1998;316:823-8.
6.
Giri S., Shaw LJ, Murthy DR et al. Impact of diabetes on the risk stratification using stress single-photon emission computed tomography myocardial perfusion imaging in patients with symptoms suggestive of coronary artery disease. Circulation2002;105:32-40.
7.
Töyry JP, Niskanen LK, Mäntysaari MJ, Länsimies EA, Uusitupa MIJ.Occurrence, predictors, and clinical significance of autonomic neuropathy in NIDDM: ten-year follow-up from the diagnosis. Diabetes1996; 45:308-15.
8.
Ambepityia G. , Kopelman PG, Ingram D., Swash M., Mills PG, Timmis ADExertional myocardial ischemia in diabetes: a quantitative analysis of anginal perceptual threshold and the influence of autonomic function. J Am Coll Cardiol1990 ;15:72-7.
9.
Marchant B., Umachandran V., Stevenson R., Kopelman PG, Timmis ADSilent myocardial ischaemia: the role of subclinical neuropathy in patients with and without diabetes. J Am Coll Cardiol1993;22:1433-7.
10.
Nesto RWScreening for asymptomatic coronary artery disease in diabetes. Diabetes Care1999;22:1393-5.
11.
Sayer JW, Timmis ADInvestigation of coronary artery disease in diabetes; is screening of asymptomatic patients necessary?Heart1997;78: 525-6.
12.
Milan Study on Atherosclerosis and Diabetes (MiSAD) Group.Prevalence of unrecognised silent myocardial ischemia and its association with atherosclerotic risk factors in non insulin-dependent diabetes mellitus. Am J Cardiol1997;79:134-9.
13.
Koistinen MJPrevalence of asymptomatic myocardial ischaemia in diabetic subjects. BMJ1990;301:92-5.
14.
Manske CL, Wilson RF, Wang Y., Thomas W.Atherosclerotic vascular complications in diabetic transplant candidates . Am J Kidney Dis1997; 29:601-7.
15.
Nesto RW, Watson FS, Kowalchuk GJ et al. Silent myocardial ischemia and infarction in diabetics with peripheral vascular disease: assessment by dipyridamole thallium-201 scintigraphy . Am Heart J1990;120:1073-7.
16.
Younis LT, Miller DD, Chaitman BRPreoperative strategies to assess cardiac risk before noncardiac surgery . Clin Cardiol1995;18:447-54.
17.
Haffner SM, Lehto S., Ronnemaa T., Pyorala K., Laakso M.Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med1998;339:229-34.
18.
Stamler J., Vaccaro O., Neaton J. et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care1993;16:434-44.
19.
United Kingdom ProspectiveDiabetes Study(UKPDS) Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ1998;317:703-13.
20.
Hansson L., Zanchetti A., Carruthers SG et al. Effects of intensive blood pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension optimal treatment (HOT) randomised trial. Lancet1998 ;352:1252-68.
21.
Collins R., Peto R., MacMahon S. et al. Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet1990 ;335:827-38.
22.
United Kingdom ProspectiveDiabetes Study(UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet1998;352:837-53.
23.
United Kingdom ProspectiveDiabetes Study(UKPDS) Group. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ2000;321:405-12.
24.
Malmberg K. , Ryden L., Efendic S. et al. for the Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction (DIGAMI) Study Group.Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction: effects on mortality at 1 year. J Am Coll Cardiol1995;26:57-65.
25.
UK Prospective Diabetes Study (UKPDS) Group.Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet1998;352:854-65.
26.
Fuchtenbusch M., Standl E., Schatz H.Clinical efficacy of new thiazolidinediones and glinides in the treatment of type 2 diabetes mellitus . Exp Clin Endocrinol Diabetes2000;108:151-63.
27.
Pyorala K., Pederson T., Kjekshus J. et al., and the Scandinavian Simvastatin Survival Study (4S) Group.Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease: a subgroup analysis of the Scandinavian Simvastatin Survival Study (4S). Diabetes Care1997;20:614-20.
28.
Sacks FM, Pfeffer MA, Moye LA et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med1996;335:1001-9.
29.
Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group.Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med1998;339:1349-57.
30.
Wood D., Durrington P., Poulter N., McInnes G., Rees A., Wray R.Joint British recommendations on prevention of coronary heart disease in clinical practice. Heart1998;80(suppl 2):1-26.
Sacks FM, Tonkin AM, Craven T. et al. Coronary heart disease in patients with low LDL-cholesterol: benefit of pravastatin in diabetics and enhanced role for HDL-cholesterol and triglycerides as risk factors. Circulation2002;105:1424-8.
33.
Rubins HB, Robins SJ, Collins D. et al. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. N Engl J Med1999;341:410-8.
34.
Davi G., Ciabottoni G., Consoli A. et al. In vivo formation of 8-iso-prostaglandin F2a and platelet activation in diabetes mellitus: effects of improved metabolic control. Circulation1999;99:224-9.
35.
Antiplatelet Trialists' Collaboration. Collaborative overview of randomised trials of randomised trials of antiplatelet therapy - 1: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ1994 ;308:81-106.
36.
The Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) Trial Investigators.Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med2001;345:494-502.
37.
Malmberg K., Herlitz J., Hjalmarson A., Ryden L.Effects of metoprolol on mortality and late infarction in diabetics with suspected acute myocardial infarction: retrospective data from two large studies. Eur Heart J1989; 10:423-8.
38.
Timmis AD, Sayer J.ACE Inhibition and Coronary Artery Disease. London : Science Press1997.
39.
Mancini GB, Henry GC, Macaya C. et al. Angiotensin-converting enzyme inhibition with quinapril improves endothelial vasomotor dysfunction in patients with coronary artery disease. The TREND (Trial on Reversing ENdothelial Dysfunction) Study. Circulation1996;94:258-65.
40.
Heart Outcomes Prevention Evaluation (HOPE) Study Investigators.Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: result of HOPE study and MICRO-HOPE substudy. Lancet2000 ;355:253-9.
41.
Lindholm LH , Ibsen H., Dahlof B. et al. Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet2002;359:1004-10.
42.
The Bypass Angioplasty Revascularization Investigation (BARI) Investigators.Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med1996;335:217-25.
43.
Niles NW, McGrath PD, Malenka D. et al. Survival of patients with diabetes and multivessel coronary artery disease after surgical or percutaneous coronary revascularization: results of a large regional prospective study. Northern New England Cardiovascular Disease Study Group. J Am Coll Cardiol2001 ;37:1008-15.
44.
Marso SP, Lincoff AM, Ellis SG et al. Optimizing the percutaneous interventional outcomes for patients with diabetes mellitus: results of the EPISTENT (Evaluation of platelet IIb/IIIa inhibitor for stenting trial) diabetic substudy. Circulation1999;100:2477-84.
45.
Bhatt DL, Marso SP, Lincoff AM, Wolski KE, Ellis SG, Topol EJAbciximab reduces mortality in diabetics following percutaneous coronary intervention . J Am Coll Cardiol2000;35:922-8.
