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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.
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