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Vol. 7. Núm. H.
Diabetología para cardiólogos
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Vol. 7. Núm. H.
Diabetología para cardiólogos
Páginas 29H-41H (Octubre 2007)
Diabetología para cardiólogos
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La enfermedad coronaria del diabético. Diagnóstico, pronóstico y tratamiento
Coronary Artery Disease in Diabetics. Diagnosis, Prognosis and Treatment
Visitas
72
Isidoro González-Maqueda
Autor para correspondencia
igonzalez.hulp@salud.madrid.org

Correspondencia: Dr. I. González-Maqueda. Servicio de Cardiología. Hospital General Universitario La Paz. P.° de la Castellana, 261. 28046 Madrid. España.
Servicio de Cardiología. Hospital General Universitario La Paz. Madrid. España
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La diabetes mellitus está presente en casi un tercio de los pacientes que presentan un síndrome coronario agudo y es considerada como un factor de riesgo cardiovascular independiente, que suele asociarse con hipertensión, obesidad y dislipemia. Las alteraciones metabólicas y hematológicas características de los diabéticos favorecen la progresión precoz, severa y rápida de la enfermedad coronaria. La prevención y el tratamiento óptimo del síndrome coronario agudo del diabético sigue siendo un desafío para la cardiología actual. El tratamiento multifactorial agresivo reduce la morbimortalidad de estos pacientes. Los bloqueadores beta y los trombolíticos proporcionan beneficio similar al de los no diabéticos, pero son infrautilizados. La mejor opción de tratamiento revascularizador, sobre todo en la enfermedad multivaso, continúa siendo controvertido. La liberación de stents y el uso de abciximab redujo de forma significativa las complicaciones de la angioplastia. Los injertos arteriales de mamaria mejoran el pronóstico a largo plazo y puede ser la mejor alternativa en la enfermedad multivaso.

Palabras clave:
Hiperglucemia
Diabetes mellitus
Cardiopatía isquémica
Abreviaturas:
AAS
ADMA
ADO
AII
AGL
ASox
BB
CA
CAM
CC
CI
CML
CV
DDAH
DM
ECV
eONs
ET
FIK 3
FT
FvWF
GP
GP IIb/IIIa
HDL
HTA
H4B
IL-6
IM
LDL
LH
LOX-1
LPL
MCP-1
NAD(P)H
NF-κB
NO
PAI-1
PCR
PDGF
PGA
PIC
PKC
PPAR
RAGE
RI
SCA
SCASEST
SOD
SRA
TG
TGF-β1
TNF-α
TRAF3
VEGF

Diabetes mellitus is present in almost one-third of patients with acute coronary syndrome. It is regarded as an independent cardiovascular risk factor that is usually associated with hypertension, obesity and dyslipidemia. The metabolic and hematological abnormalities characteristic of diabetes predispose to the early and rapid progression of severe coronary artery disease. The prevention and optimum treatment of acute coronary syndrome in diabetics provides an ongoing challenge for today's cardiologists. Aggressive combination treatment can reduce morbidity and mortality in these patients. Beta-blockers and thrombolytics have demonstrated benefits similar to those observed in non-diabetic patients, but they are underused. In addition, there is still some controversy about the best approach to revascularization, particularly for multivessel disease. The introduction of stents and the use of abciximab have significantly reduced complications associated with angioplasty. The use of internal mammary artery grafts has improved long-term prognosis and may be the best option for multivessel disease.

Key words:
Hyperglycemia
Diabetes mellitus
Ischemic heart disease
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