Optimal treatment of chronic angina in patients with type 2 diabetes mellitus

Abstract

Type 2 diabetes mellitus (T2DM) trebles the risk of developing coronary artery disease (CAD); once CAD has developed, the risk of acute coronary syndromes (ACS) and clinical risk associated with a coronary event, both double in diabetic patients. Patients with T2DM have more extensive CAD and present at a younger age; therefore, identification and management of chronic angina in these patients presents an opportunity to limit both cardiovascular symptoms and adverse outcomes. This article reviews the role of screening and treatment for chronic angina in patients with T2DM. There is a strong evidence base for modifying lifestyle as a way of reducing adverse cardiovascular outcomes in the diabetic population and this article reviews evidence of lifestyle modification as an important and necessary adjunct to pharmacologic intervention. Management of chronic stable angina is addressed by looking at treatments that reduce ischemic symptoms and those that reduce adverse cardiovascular outcomes. Trials specific to the diabetic population are limited, with information largely obtained from the diabetic subgroup analysis of large intervention trials. The growing diabetic population with increased propensity to cardiovascular disease mandates trials specifically in this patient population. Revascularization in patients with diabetes is associated with more complications than in the non-diabetic population. Recent trials specific to this population suggest surgical revascularization to be associated with better long-term outcomes and therefore, this article reviews the evidence for the optimal mode of revascularization in this population.

Antianginal effects of empagliflozin in patients with type 2 diabetes and refractory angina; a randomized, double‐blind placebo‐controlled trial (EMPT‐ANGINA Trial)

“…5 The effectiveness of antianginal drugs in patients who have both stable angina and T2DM is not well studied. 6 Some antianginal medications, such as beta-blockers and calcium channel blockers, can worsen the glycemic control of these patients, so it is important to choose anti-anginal drugs that have a neutral or positive impact on them. 10,11 Some non-antianginal agents, such as thiazolidinediones and metformin, have been evaluated for angina treatment among these patients.…”

“…3,4 The term "refractory angina" (RA) refers to the chronicity of symptoms (≥3 months in duration) and failure of symptom control with a combination of optimal medical therapy and revascularization methods. [5][6][7] Between 5% and 10% of patients who undergo cardiac catheterization have RA. However, there is no specific data on how this condition affects diabetic patients.…”