DOI: https://doi.org/10.22141/2224-0721.6.70.2015.72632

Peculiarities of Ischemic Heart Disease Course and Treatment in Patients with Glucose Metabolism Impairment and Diabetes Mellitus

O.M. Radchenko, O.Ya. Кoroliuk

Abstract


Combination of ischemic heart disease and diabetes mellitus is characterized by certain features of clinical picture and insufficient effectiveness of treatment of ischemic heart disease. With the aim of investigation of pathogenic mechanisms and features of the clinical course of ischemic heart disease associated with glucose homeostasis violation we examined 116 patients (51 women, 65 men, median of age 63 years old) with normal regulation of glucose metabolism (NRG, n = 24), changes in fasting glucose (n = 23), violated glucose tolerance (n = 21), combined violation (n = 24) and diabetes mellitus (n = 24). We also conducted their prospective observation for 40 months with the following endpoints — hospitalization because of cardiovascular complications, death from them and the emergence of diabetes. It was established that ischemic heart disease associated with prediabetic disorders and diabetes mellitus has the following peculiarities: earlier clinical manifestation in women; more frequent and severe heart failure; lower tolerance to physical load in patients with angina pectoris; atypical manifestation of ischemic pain: longer attacks, atypical localization or absent pain; frequent combination with arrhythmias and conduction disorders; frequent affection of multiple coronary arteries, which leads to myocardial infarction with complicated course; eccentric type of left ventricle remodeling; significant calcification of mitral and aortic valves of heart.
The main principles of treatment of ischemic heart disease: weight loss; active correction of glucose metabolism violations using medications (metformin) even at the stage of prediabetes, because in chronic stable forms of ischemic heart disease metformin significantly improves glucose metabolism, decreases insulin resistance and does not increase the incidence of cardiovascular complications and decompensations of heart failure; the basic drugs for treatment of ischemic heart disease should be chosen taking into account their impact on glucose metabolism with avoidance of drugs and treatment schemes, which lead to its impairment; usage of well-targeted drugs with clear indications as there is a lasting need for large number of drugs with unpredictable interactions.


Keywords


ischemic heart disease; diabetes mellitus; changes in fasting glucose; violated glucose tolerance; combined violation; course peculiarities; principles of treatment

References


Королюк О.Я., Радченко О.М. Уперше виявлена гіперглікемія у хворих на ішемічну хворобу серця з точки зору кардіолога // Міжнародний ендокринологічний журнал. — 2011. — № 7. — С. 95-102.

Королюк О.Я., Радченко О.М., Горбач Л.О., Горбач М.О. Особливості діагностики вперше виявленої гіперглікемії у хворих на ішемічну хворобу серця // Кровообіг та гемостаз. — 2011. — № 3–4. — С. 23-28.

Радченко О.М., Королюк О.Я. Бета-адреноблокатори: вплив на вуглеводний метаболізм // Рациональная фармакотерапия. — 2013. — № 3. — С. 40-44.

Радченко О.М., Королюк О.Я. Застосування діуретиків за умов порушеного вуглеводного метаболізму // Рациональная фармакотерапия. — 2013. — № 2. — С. 14-17.

Сахарный диабет и ишемическая болезнь сердца: поиски решения / Александров А.А., Бондаренко И.З., Кухаренко С.С. [и др.] // Електр. ресурс. Режим доступу: http://cyberleninka.ru/article/n/saharnyy-diabet-i-ishemicheskaya-bolezn-serdtsa-poiski-resheniya

Andreotti F., Marchese N. Women and coronary disease // Heart. — 2008. — Vol. 94. — P. 108-116.

Association between plasma LDL particle size, valvular accumulation of oxidized LDL, and inflammation in patients with aortic stenosis / D. Mohty, P. Pibarot, J.-P. Després [et al.] // Arterioscler. Thromb. Vasc. Biol. — 2008. — Vol. 28. — P. 187-193

Atypical chest pain in the elderly: prevalence, possible mechanisms and prognosis / C.-L. Hung, C.J.-Y. Hou, H.-I. Yeh, W.-H. Chang // International Journal of Gerontology. — 2010. — Vol. 4. — P. 1-8.

Effects of 1-year treatment with metformin on metabolic and cardiovascular risk factors in non-diabetic upper-body obese subjects with mild glucose anomalies: A post-hoc analysis of the BIGPRO1 trial / A. Fontbonne, I. Diouf, M. Baccara-Dinet [et al.] // Diabetes and Metabolism. — 2009. — Vol. 35. — P. 385-391.

Impaired Fasting Glucose and Impaired Glucose Tolerance: Implications for care / D.M. Nathan, M.B. Davidson, R.A. DeFronzo [et al.] // Diabetes Care. — 2007. — Vol. 30. — P. 753-759.

Insulin signaling in the heart / L. Bertrand, S. Horman, C. Beauloye, J.L. Vanoverschelde // Cardiovasc. Res. — 2008. — Vol. 79. — P. 238-248.

Is the current definition for diabetes relevant to mortality risk from all causes and cardiovascular and noncardiovascular diseases? / The DECODE Study Group, European Diabetes Epidemiology Group // Diabetes Care. — 2003. — Vol. 26. — P. 688-696.

Maddalone S.T.M. Metformin use in patients with diabetes and heart failure: cause for concern? // Diabetes Spectrum. — 2009. — Vol. 22. — P. 18-20.

The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. The Euro Heart Survey on diabetes and the heart / M. Bartnik, L. Rydén, R. Ferrari [et al.] // Eur. Heart J. — 2004. — Vol. 25. — P. 1880-1890.

What is a normal glucose value? Differences in indexes of plasma glucose homeostasis in subjects with normal fasting glucose / M.V. Piche, J.-F. Arcand-Bosse, J.-P. Despres [et al.] // Diabetes Care. — 2004. — Vol. 27. — P. 2470-2477.






Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© "Publishing House "Zaslavsky", 1997-2019

 

   Seo анализ сайта