Tag Archives: diabetes

Introduction Developments along the way have included better patient selection, improved peri-procedural management of patients and, with newer-generation drugs and devices, better results. Recent hurdles have been confronted, including left main stem disease, complex bifurcation lesions and total chronic occlusions. Similarly, primary percutaneous coronary intervention (PCI) has become the treatment of choice in acute myocardial infarction. Challenges remain, however, including restenosis. The fine balance between thrombosis and haemostasis demands that we provide more effective and predictable antiplatelet strategies to optimise risk reduct

Introduction While primary PCI, rather than thrombolysis, is now the reperfusion treatment of choice for STEMI, the majority of patients coming for revascularisation in the UK have stable coronary disease or NSTE-ACS. In the treatment of NSTE-ACS, first principles involve the selection of patients for diagnostic angiography followed by either PCI or coronary artery bypass grafting (CABG). Rates of PCI are increasing annually in the UK, which, in part, is a reflection of greater awareness of coronary artery disease, its earlier diagnosis and treatment in the ageing population. This section looks at coronary intervention in general, how PCI act

Introduction The discovery of the thienopyridines, or ADP receptor antagonists, led to the development of more effective oral antiplatelet agents. Trials assessed dual antiplatelet therapy in high-risk patients versus aspirin alone and the significant benefits observed have resulted in dual antiplatelet therapy becoming a mainstay of treatment. As expected with more potent dual therapy, there is always a fine balance between prevention of thrombosis and bleeding risk. There are still many challenges to overcome. Many patients, such as those with diabetes or with a previous stent thrombosis, are at high risk for further infarction, indicating

Increase in kidney failure in people with diabetes Diabetes UK has reported ‘concern’ in recently released figures showing a 20% increase in people with diabetes in England needing dialysis or a kidney transplant between 2008–2009. The figures released by the National Diabetes Audit also reveals, for the same period, that a third of people with diabetes did not have their urine tested, half of people with diabetes were found to have not met their blood pressure targets, and more than a third were found to have poor blood glucose control, with the latter more prevalent in younger people with diabetes. Data for the audit was contributed f

Renal disease and diabetes Microalbuminuria is known to be a marker of increased cardiovascular (CV) risk. It is not clear whether reducing microalbuminuria on its own is associated with an improved cardiovascular prognosis, but in secondary analyses from studies of angiotensin receptor blockers (ARBs) in people with type 2 diabetes, reduction in albuminuria was associated with a decreased risk of a CV event. Observational analyses from the RENAAL trial found that the magnitude of albuminuria reduction predicted the reduced risk of CV events (figure 1).1 Figure 1. Kaplan-Meier curves for cardiovascular (CV) and heart failure end points, strat

ACCORD/INVEST: do not aim for normal blood pressure in diabetes patients with CAD The results of two trials comparing intensive versus more conventional blood pressure lowering in patients with diabetes at high cardiovascular risk have suggested that intensive treatment is not necessary and may be harmful in this population. In the ACCORD BP (Action to Control Cardiovascular Risk in Diabetes – Blood Pressure) trial, while intensive blood pressure treatment did reduce the risk of stroke, it failed to reduce the overall risk of cardiovascular events in patients and was associated with an increase in adverse events due to antihypertensive ther

New pocket-sized visualisation tool This new pocket-sized visualisation tool provides ultrasound technology at the point-of-care. Similar in size to a mobile phone and weighing less than one pound, it can give high quality colour images enabling physicians to take a quick look inside the body and detect disease earlier. Vscan™ is marketed by GE Healthcare and has received the CE Mark by the European Union. Heart failure report published A comprehensive review of the quality of heart failure care in England Bridging the quality gap: heart failure, has been published by The Health Foundation. It highlights that prevention is key to imp

These findings are in line with those of the US ACCORD trial which was stopped early because of an increased risk of death in type 2 diabetes patients who underwent intensive blood glucose lowering compared with conventional therapy. In the new UK study, published recently in The Lancet (Lancet 2010;375:481–9), the lowest death and event rates were seen at an HbA1c level of 7.5%. The new data come from studying around 48,000 type 2 diabetes patients aged 50 or over who are included in the UK General Practice Research Database. These patients had either had their treatment intensified from oral monotherapy to combination therapy with oral bl

They note that trials of statin therapy have had conflicting findings on the risk of development of diabetes. They therefore performed a meta-analysis of published and unpublished data to look at this issue further. They included 13 statin trials with 91,140 participants in total, of whom 4,278 had diabetes during a mean of four years. Treatment of 255 patients with statins for four years resulted in one extra case of diabetes. They conclude that the risk of developing diabetes with statin therapy is low both in absolute terms and when compared with the reduction in coronary events, and that “Clinical practice in patients with moderate or h

Identifying targets in the thrombosis pathway Figure 1. Central role of platelets and interaction with coagulation in the genesis of thrombosis (1) Figure 1 summarises the central role of platelets in the genesis of thrombosis.1 The platelet is initially activated in response to shear stress, events such as percutaneous coronary intervention (PCI) or plaque rupture, and the release of local agonists and exposure of the subendothelial components to flowing blood. Tissue factor ‘lights the fire’ by producing minute quantities of thrombin which then amplify the process. Binding of platelets to collagen and von Willebrand