Optimisation of the management of patients with coronary heart disease andtype 2 diabetes mellitus

Type 2 diabetes mellitus is a prevalent disease in Westernised society, and more than 50% of individuals with diabetes mellitus die from cardiovascula r causes. The underlying metabolic defect of type 2 diabetes mellitus is a combination of insulin resistance and decreased secretion of insulin by pan creatic beta -cells. Insulin resistance commonly precedes the onset of type 2 diabetes mellitus and is usually associated with a metabolic syndrome in cluding hypertension, dyslipidaemia and obesity. Treatment of known cardiov ascular risk factors, including hyperglycaemia, dyslipidaemia, hypertension and smoking, plays a key role in delaying the onset and progression of cor onary heart disease (CHD) and other forms of atherosclerosis in patients wi th diabetes mellitus. Sulphonylureas should be used with caution in patients with CHD but aspirin (acetylsalicylic acid), beta -blockers and ACE inhibitors play an importan t role in the medical management of patients with established coronary arte ry disease and diabetes mellitus. Patients with diabetes mellitus represent a higher risk group of patients a fter both percutaneous and surgical coronary revascularisation and the deci sion regarding the choice of revascularisation procedure should take into a ccount angiographic characteristics, clinical status and patient preference . Patients presenting with diabetes mellitus and acute myocardial infarction should be considered for reperfusion therapy with either urgent thrombolyti c therapy or primary percutaneous coronary intervention.