Principal of Medical Management of Ischemic Heart Disease in Diabetic Patients*

The leading cause of death in patients with diabetes mellitus in the West is ischemic heart disease. Both in Japan and Asian countries, mortality due to ischemic heart diseases is on the rise and is most significant as the cause of death in diabetic patients. Ischemic heart disease seen in diabetic patients is associated with severe coronary artery lesions, with relatively few symptoms; and its discovery is often delayed. Acute myocardial infarction complicated by diabetes mellitus, when compared to a simple myocardial infarction, is associated with high mortality during the acute stage, an unsatisfactory outcome of coronary artery reconstruction, a high rate of recurrence, and poor prognosis. On the other hand, epidemiological surveys have established that diabetes mellitus is a significant risk factor for the development of ischemic heart disease. Recently, the results from a number of extensive clinical studies have been introduced on diabetic patients, in which the development of ischemic heart disease was used as the end point of the evaluation. These studies indicated that the control of blood pressure and lipid metabolism are more important than the management of blood sugar levels. With advances in diagnostic techniques, such as electron-beam computed tomography and transthoracic Doppler echocardiography, non-invasive detection of coronary artery lesions became possible. The principal means for managing ischemic heart diseases in diabetic patients are treatment based on scientific evidences obtained from clinical megatrials and early diagnosis by employing the latest non-invasive diagnostic procedures.