Prevention and management of coronary artery disease in patients with diabetes mellitus.

Diabetes mellitus (DM) is a common medical problem and a major risk factor for the development of atherosclerotic coronary artery disease (CAD). Coronary artery disease is highly prevalent and is the major cause of morbidity and mortality in diabetic patients. Patients with CAD and prediabetic states should undergo lifestyle modifications aimed at preventing DM. In patients with CAD and DM, routine use of aspirin and an angiotensin-converting enzyme inhibitor (ACE-I)-unless contraindicated or not tolerated-and strict glycemic, blood pressure, and lipid control are strongly recommended. Intense insulin therapy might be needed for glycemic control, and high-dose statin therapy might be needed for lipid control. For blood pressure control, ACE-Is and angiotensin receptor blockers are considered as first-line therapy. The outcomes after revascularization in diabetic patients are usually worse compared with non-diabetic patients. Advances in PCI include the use of drug-eluting stents and adjunctive drug therapies, such as abciximab. Glycemic control is an important determinant of outcome after revascularization in diabetic patients. Improvements in PCI and coronary artery bypass graft surgery are leading to better results in diabetic patients, and clinical trials are presently comparing contemporary PCI with surgery.