Features of the development of atherosclerosis in a patient with diabetes mellitus are presented in this article on the example of a clinical case. Atherosclerotic changes progress not only faster, but also earlier in patients with diabetes mellitus, while reducing their life expectancy. Patients with diabetes are characterized by an increased risk of developing cardiovascular disease. A feature of diabetes mellitus contributing to this is the accelerated atherosclerosis. In patients with diabetes mellitus, compared with patients without this disease, even though normal levels of low-density lipoprotein cholesterol in the blood are achieved, the progress of atherosclerotic changes is associated with poor glycemic control. The purpose of the study was to analyze the features of the course of coronary heart disease on the example of a clinical case of a patient with the rapid development of atherosclerosis. Material and methods. A 55-year-old man was with complaints for dyspnea attacks at night, stopped in a sitting position, sometimes dyspnea attacks were accompanied by pain in the chest, transient rises of blood pressure, headaches. Anamnesis is remarkably significant for arterial hypertension (max 240/180 mm Hg, adapted to 130-140/80 mm Hg), he took antihypertensive therapy. Three years in a row, the patient has had surgery for stenting of the coronary arteries. Clinical diagnosis: Ischemic heart disease. Stable angina, II functional class. Arterial hypertension, II stage, 3 degree. Coronary vascular disease risk was very high. Atherosclerosis of the coronary arteries. Right coronary artery stenting (22.05.17), anterior descending artery stenting (13.12.18). Ventricular extrasystolic arrhythmia with episodes of unstable ventricular tachycardia. Heart failure III FC, stage C. Diabetes mellitus II type, insulin-dependent, severe degree, decompensation. Diabetic polyneuropathy. Obesity, III degree. The article presents the analysis of the clinical case of a patient with coronary heart disease, expressed atherosclerosis with diabetes mellitus type 2. In this regard, the issues of choosing the tactics of sugar-lowering therapy and the additive effect of drugs based on randomized clinical trials are discussed. Conclusion. Atherosclerotic changes develop not only faster, but also earlier in patients with diabetes, while reducing their life expectancy. In patients with diabetes compared with those without this disease, even though a normal in cholesterol level of low-density lipoproteins in the blood achieved, poor glycemic control in patients with diabetes mellitus is associated with the progression of atherosclerotic changes.

Keywords: coronary artery disease, diabetes mellitus, cardiovascular risk factors, atherosclerosis

Full text: PDF (Eng) 195K

1. Lanza GA, Crea F. Cardiopatia ischemica. In: Medicina Interna Sistematica. 6th ed. Vol 1. Milan, Italy: Elselvier Italia srl; 2010. p. 103-49.
2. Kalofoutis C, Piperi C, Kalofoutis A, Harris F, Phoenix D, Singh J. Type II diabetes mellitus and cardiovascular risk factors: Current therapeutic approaches. Exp Clin Cardiol. 2007; 12(1): 17‐28.
3. World Health Organization. Global Report on Diabetes. Geneva, Switzerland: World Health Organization; 2016.
4. Wang CCL, Hess CN, Hiatt WR, Goldfine AB. Clinical Update: Cardiovascular Disease in Diabetes Mellitus. Circulation. 2016; 133: 2459-502. https://doi.org/10.1161/CIRCULATIONAHA.116.022194. https://www.ncbi.nlm.nih.gov/pubmed/27297342. https://www.ncbi.nlm.nih.gov/pmc/articles/4910510
5. Selvin E, Steffes MW, Zhu H, Matsushita K, Wagenknecht L, Pankow J, et al. Glycated hemoglobin, diabetes and cardiovascular risk in nondiabetic adults. N Engl J Med. 2010; 362: 800-11. https://doi.org/10.1056/NEJMoa0908359. https://www.ncbi.nlm.nih.gov/pubmed/20200384. https://www.ncbi.nlm.nih.gov/pmc/articles/2872990
6. Santos-Oliveira R, Purdy C, da Silva MP, dos Anjos Carneiro-Leao AM, Machado M, Einarson TR. Haemoglobin A1c levels and subsequent cardiovascular disease in persons without diabetes: A meta-analysis of prospective cohorts. Diabetologia. 2011; 54: 1327-34. https://doi.org/10.1007/s00125-011-2078-8. https://www.ncbi.nlm.nih.gov/pubmed/21340623
7. Mogensen CE. New treatment guidelines for a patient with diabetes and hypertension. J Hypertens Suppl. 2003; 21: S25-S30. https://doi.org/10.1097/00004872-200305002-00005. https://www.ncbi.nlm.nih.gov/pubmed/12929904
8. Sarwar N, Gao P. Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: A collaborative meta-analysis of 102 prospective studies. Lancet. 2010; 375: 2215-22. https://doi.org/10.1016/S0140-6736(10)60484-9
9. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation. 2002; 106: 3143-421. https://doi.org/10.1161/circ.106.25.3143
10. Berthezène F. Diabetic dyslipidaemia. Br J Diabetes Vasc Dis. 2002; 2(Suppl 1): S12-7. https://doi.org/10.1177/1474651402002001S0401
11. Reaven GM. Insulin resistance: Why is it important to treat? Diabetes Metab. 2001; 27: 247-53.
12. Panchenko EP. Yshemycheskaya bolezn serdtsa y sakharnyy dyabet - kovarnyy tandem [Coronary heart disease and diabetes - an insidious tandem]. Serdtse. 2004; 1(13): 9-12. [Russian]
13. Papanova EY, Korneva KG. Osobennosty arytmyy serdtsa u bolnykh sakharnym dyabetom2 typa [Features of cardiac arrhythmias in patients with type 2 diabetes mellitus]. Klyn medytsyna. 2006; 7: 21-4. [Russian]
14. Kuchulakanti PK, Torguson R, Canos D, Rha SW, Chu WW, Clavijo L, et al. Impact of treatment of coronary artery disease with sirolimus-eluting stents on outcomes of diabetic and nondiabetic patients. Am J Cardiol. 2005 Oct 15; 96(8): 1100-6. https://doi.org/10.1016/j.amjcard.2005.06.031. https://www.ncbi.nlm.nih.gov/pubmed/16214445
15. Colwell JA; American Diabetes Association. Aspirin therapy in diabetes. Diabetes Care. 2003; 26(Suppl 1): S87-8. https://doi.org/10.2337/diacare.26.2007.S87. https://www.ncbi.nlm.nih.gov/pubmed/12502626
16. Haffner SM; American Diabetes Association. Management of dyslipidemia in adults with diabetes. Diabetes Care. 2003; 26(Suppl 1): S83-6. https://doi.org/10.2337/diacare.26.2007.S83. https://www.ncbi.nlm.nih.gov/pubmed/12502625
17. Heart Outcomes Prevention Evaluation Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: Results of the HOPE study and MICRO-HOPE substudy. Lancet. 2000; 355: 253-9. https://doi.org/10.1016/S0140-6736(99)12323-7
18. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998 Sep 12; 317(7160): 703-13. https://doi.org/10.1136/bmj.317.7160.703. https://www.ncbi.nlm.nih.gov/pmc/articles/28659
19. Kessler C, Thomas K, Kao J. Antiplatelet therapy for secondary prevention of acute coronary syndrome, transient ischemic attack, and noncardioembolic stroke in an era of cost containment. J Investig Med. 2012. 60(5): 792-800. https://doi.org/10.2310/JIM.0b013e31824e9a50. https://www.ncbi.nlm.nih.gov/pubmed/22460233
20. Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, et al. 2016 ESC/EAS guidelines for the management of dyslipidaemias. Eur Heart J. 2016; 37: 2999-3058. https://doi.org/10.1093/eurheartj/ehw272. https://www.ncbi.nlm.nih.gov/pubmed/27567407
21. Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm: 2018 executive summary. Endocr Pract. 2018; 24: 91-120. https://doi.org/10.4158/CS-2017-0153. https://www.ncbi.nlm.nih.gov/pubmed/29368965