Management of diabetes with coronary artery disease

Persons with cardiovascular disease (CVD) and diabetes consistently have worse clinical outcomes than those without diabetes. Treatment of diabetes with CVD must target blood pressure, cholesterol, and glycemic targets. Control of blood pressure to <- 130/80 mm Hg and low-density lipoprotein cholesterol to less than 100 mg/dL is key to preventing and managing CVD with diabetes. Optimal glucose control should be a goal in treating diabetes and CVD, in both hospital and outpatient settings. This article focuses on the oral antihyperglycemic agents and insulins available for diabetes pharmacotherapy. Effective glucose management using these agents when interventional procedures and cardiac surgery are to be performed is possible. Practical strategies include combination therapies and use of insulins subcutaneously or by intravenous infusion. Emerging therapies may impact outcomes for diabetes with CVD, including use of insulin sensitizers, drug-eluting stents, and brachytherapy. Attention is currently focused on the insulin sensitizers (metformin and thiazolidinediones), as they appear to impact processes related to the insulin resistance syndrome and the vascular pathophysiologic changes of atherosclerosis. It remains to be seen whether or not the insulin-sensitizing agents will confer a definitive advantage in treating the patient with diabetes for the prevention of or intervention for CVD.