STABLE ANGINA IN SPECIAL SITUATIONS: DIABETES

In the next two decades, the epidemic of type 2 diabetes (T2DM), which is often accompanied by other comorbidities, such as hypertension, obesity and dyslipidemia, is expected to affect more than 600 million people. T2DM has a great impact on the survival and quality of life of patients with stable angina, especially in younger patients and in those with multiple comorbidities. Although all T2DM complications are equally relevant, cardio-vascular disease and coronary artery disease (CAD) are especially important, as they are the main causes of morbidity and mortality in this group of patients. Despite the fact that in the last 15 years there has been a significant decline in the rates of acute myocardial infarction, stroke and amputations in patients with T2DM, ischemic complications have reappeared, especially in younger and middle-aged individuals. These data reveal the need for increased attention to the implementation of cardiovascular risk control measures in patients with T2DM, especially in those with established CAD. Thus, in order to improve the survival and quality of life of diabetic patients, the most diverse national and international societies recognize the prevention of vascular ischemic events as one of their main priorities. Although comprehensive strategies to control cardiovascular risk have been shown to be efficient in patients with T2DM, rates of cardiovascular events remain high among these individuals, even with adequate control of modifiable risk factors — as seen in recent clinical studies. This reinforces the need for additional measures to control events in this population. Fortunately, several recent therapeutic strategies have become available in recent years, including advances in anticoagulation and antiplatelet therapy, new cholesterol-lowering drugs, and new agents to control blood glucose with potential cardiovascular benefits.This chapter discusses the main therapeutic strategies to be implemented in patients with T2DM and stable angina, in order to optimize the reduction of cardiovascular events, control of symptoms and improvement of quality of life.