Гликемический контроль как компонент профилактики стенозирования у пациентов с сахарным диабетом типа 2 до и после чрескожных коронарных вмешательств
Гликемический контроль как компонент профилактики стенозирования у пациентов с сахарным диабетом типа 2 до и после чрескожных коронарных вмешательств
Салухов В.В., Кадин С.В., Аглиуллин А.Ф. Гликемический контроль как компонент профилактики стенозирования у пациентов с сахарным диабетом типа 2 до и после чрескожных коронарных вмешательств. Consilium Medicum. 2016; 18 (10): 24–28. DOI: 10.26442/2075-1753_2016.10.24-28
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Salukhov V.V., Kadin S.V., Agliullin A.F. Glycemic control as a part of coronary stenosis prevention strategy in type 2 diabetes patients before and after transcutaneous coronary intervention. Consilium Medicum. 2016; 18 (10): 24–28. DOI: 10.26442/2075-1753_2016.10.24-28
Гликемический контроль как компонент профилактики стенозирования у пациентов с сахарным диабетом типа 2 до и после чрескожных коронарных вмешательств
Салухов В.В., Кадин С.В., Аглиуллин А.Ф. Гликемический контроль как компонент профилактики стенозирования у пациентов с сахарным диабетом типа 2 до и после чрескожных коронарных вмешательств. Consilium Medicum. 2016; 18 (10): 24–28. DOI: 10.26442/2075-1753_2016.10.24-28
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Salukhov V.V., Kadin S.V., Agliullin A.F. Glycemic control as a part of coronary stenosis prevention strategy in type 2 diabetes patients before and after transcutaneous coronary intervention. Consilium Medicum. 2016; 18 (10): 24–28. DOI: 10.26442/2075-1753_2016.10.24-28
Сахарный диабет типа 2 (СД 2) по праву считается одним из наиболее значимых факторов риска развития сердечно-сосудистых заболеваний в популяции, при этом его также выделяют в качестве предиктора неблагоприятного течения ранее диагностированной ишемической болезни сердца (ИБС). Высокий сердечно-сосудистый риск реализуется благодаря таким особенностям течения коронарного атеросклероза при диабете, как большая протяженность поражения, его многососудистость и большая степень стенозирования. Современные возможности чрескожных коронарных вмешательств позволили существенно улучшить как выживаемость, так и качество жизни пациентов с ИБС. Однако больные СД 2 чаще подвержены повторным процедурам по причине развития рестеноза. В публикации освещены вопросы влияния контроля показателей углеводного обмена у больных СД на различные аспекты прогрессирования ИБС, а также на развитие внутристентовых рестенозов у пациентов c СД 2, подвергшихся чрескожным коронарным вмешательствам. Рассмотрены различные аспекты патогенеза рестенозов стентов и перспективные пути их профилактики.
Ключевые слова: сахарный диабет типа 2, ишемическая болезнь сердца, чрескожное коронарное вмешательство, рестеноз внутри стента, контроль гликемии.
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Diabetes mellitus type 2 (DM 2) is judgefully beleaved to be one of the most sufficient populational risk factors for cardiovascular diseases, and is supposed to be the predictor of unfavorable currence of previously diagnosed coronary heart disease (CAD). Increased cardiovascular hazard in DM 2 is realized due to such coronary atherosclerosis peculiarities as more extensive, multivessel lesion and a bigger stenosis degree. Modern percutaneous coronary intervention (PCI) facilities provide significant survival and quality of life improvement. But there are more frequent target lesion revascularization in DM 2 patients for restenosis. The article covers some questions concerning the influence of glycemic control in DM 2 on different features of CAD progression and in-stent restenosis development in DM 2 patients who underwent PCI. Different aspects of restenosis pathogenesis and prevention are illuminated.
1. Hurst RT, Lee RW. Increased incidence of coronary atherosclerosis in type 2 diabetes mellitus: mechanisms and management. Ann Intern Med 2003; 139: 824–34.
2. Kip KE, Faxon DP, Detre KM et al. Coronary angioplasty in diabetic patients. The National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. Circulation1996; 94: 1818–25.
3. 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.
4. Stamler J, Vaccaro O, Neaton JD et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care1993; 16: 434–44.
5. Alderman EL, Corley SD, Fisher LD et al. Five-year angiographic follow-up of factors associated with progression of coronary artery disease in the Coronary Artery Surgery Study (CASS). J Am Coll Cardiol 1993; 22: 1141–54.
6. Diabetes Control and Complications Trial (DCCT) Research Group. Effect of intensive diabetes management on macrovascular events and risk factors in the diabetes control and complications trial. Am J Cardiol 1995; 75: 894–903.
7. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet 1998; 352: 837–53.
8. The 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 (9733): 2215–22.
9. Laakso M. Hyperglycemia and cardiovascular disease in type 2 diabetes. Diabetes 1999; 48: 937–42.
10. Wannamethee SG, Shaper AG, Lennon L. Cardiovascular disease incidence and mortality in older men with diabetes and in men with coronary heart disease. Heart 2004; 90: 1398–403.
11. Fisher M. Diabetes: can we stop the time bomb? Heart 2003; 89 (Suppl. 2): 28–30.
12. Акчурин Р.С., Власова Э.Е., Мершин К.В. Сахарный диабет и хирургическое лечение ишемической болезни сердца. Вестн. РАМН. 2012; 1: 14–9. / Akchurin R.S., Vlasova E.E., Mershin K.V. Sakharnyi diabet i khirurgicheskoe lechenie ishemicheskoi bolezni serdtsa. Vestn. RAMN. 2012; 1: 14–9. [in Russian]
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17. Dluhy RG, McMahon GT. Intensive glycemic control in the ACCORD and ADVANCE trials. N Engl J Med 2008; 358 (24): 2630–3.
18. LeRoith D, Fonseca V, Vinik A. Metabolic memory in diabetes – focus on insulin. Diabetes Metab Res Rev 2005; 21 (2): 85–90.
19. Mick MJ, Piedmonte MR, Arnold AM et al. Risk stratification for long-term outcome after elective coronary angioplasty: a multivariate analysis of 5,000 patients. J Am Coll Cardiol 1994; 24: 74–80.
20. The BARI Investigators. The Final 10-Year Follow-Up Results Fr om the BARI Randomized Trial. J Am Coll Cardiol 2007; 49: 1600–6.
21. Mathew V, Gersh BJ, Williams BA et al. Outcomes in patients with diabetes mellitus undergoing percutaneous coronary intervention in the current era: a report from the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial. Circulation 2004; 109: 476–80.
22. West NE, Ruygrok PN, Disco CM et al. Clinical and angiographic predictors of restenosis after stent deployment in diabetic patients. Circulation 2004; 109: 867–73.
23. Mazeika P, Prasad N, Bui S et al. Predictors of angiographic restenosis after coronary intervention in patients with diabetes mellitus. Am Heart J 2003; 145: 1013–21.
24. Holmes DR Jr, Leon MB, Moses JW et al. Analysis of 1-year clinical outcomes in the SIRIUS trial: a randomized trial of a sirolimus-eluting stent versus a standard stent in patients at high risk for coronary restenosis. Circulation 2004; 109: 634–40.
25. Byrne RA, Joner M, Kastrati A. Stent thrombosis and restenosis: what have we learned and wh ere are we going. Eur Heart J 2015; 36 (47): 3320–31.
26. Legrand V. Therapy insight: Diabetes and drug-eluting stents. Nat Clin Pract Cardiovasc Med 2007; 4: 143–50.
27. Fröbert O, Lagerqvist B, Carlsson J et al. Differences in restenosis rate with different drug-eluting stents in patients with and without diabetes mellitus: a report from the SCAAR (Swedish Angiography and Angioplasty Registry). J Am Coll Cardiol 2009; 53 (18): 1660–7.
28. Hong SJ, Kim MH, Ahn TH et al. Multiple predictors of coronary restenosis after drug-eluting stent implantation in patients with diabetes. Heart 2006; 92: 1119–24.
29. Svedman C, Ekqvist S, Moller H et al. A correlation found between contact allergy to stent material and restenosis of the coronary arteries. Contact Dermatitis 2009; 60: 158–64.
30. Березовская Г.А., Ганюков В.И., Карпенко М.А. Рестеноз и тромбоз внутри стента: патогенетические механизмы развития и прогностические маркеры. Рос. кардиол. журн. 2012; 6 (98): 91–5. / Berezovskaia G.A., Ganiukov V.I., Karpenko M.A. Restenoz i tromboz vnutri stenta: patogeneticheskie mekhanizmy razvitiia i prognosticheskie markery. Ros. kardiol. zhurn. 2012; 6 (98): 91–5. [in Russian]
31. Tian F, Chen Y, Liu H et al. Assessment of characteristics of neointimal hyperplasia after drug-eluting stent implantation in patients with diabetes mellitus: an optical coherence tomography analysis. Cardiology 2014; 128 (1): 34–40.
32. Ломоносова А.А., Григорова С.Ю., Афанасьев Ю.И. Проблема рестеноза после чрескожных внутрикоронарных вмешательств и перспективы его профилактики с помощью генотерапевтических воздействий. Науч. ведомости. 2010; 4 (75; Вып. 9). / Lomonosova A.A., Grigorova S.Iu., Afanas'ev Iu.I. Problema restenoza posle chreskozhnykh vnutrikoronarnykh vmeshatel'stv i perspektivy ego profilaktiki s pomoshch'iu genoterapevticheskikh vozdeistvii. Nauch. vedomosti. 2010; 4 (75; Vyp. 9). [in Russian]
33. Aronson D, Bloomgarden Z, Rayfield EJ. Potential mechanisms promoting restenosis in diabetic patients. J Am Coll Cardiol 1996; 27: 528–35.
34. Kereiakes DJ, Young JJ. Percutaneous coronary revascularization of diabetic patients in the era of drug-eluting stents. Rev Cardiovasc Med 2005; 6 (Suppl. 1): S48–58.
35. Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA 2002; 287: 2570–81.
36. Sobel BE. Increased plasminogen activator inhibitor-1 and vasculopathy: a reconcilable paradox. Circulation 1999; 99: 2496–8.
37. Yusuf S, Zhao F, Mehta SR et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345: 494–502.
38. Choi D, Kim SK, Choi SH et al. Preventative effects of rosiglitazone on restenosis after coronary stent implantation in patients with type 2 diabetes. Diabetes Care 2004; 27: 2654–60.
39. Dibra A, Kastrati A, Mehilli J et al. Paclitaxel-eluting or sirolimus-eluting stents to prevent restenosis in diabetic patients. N Engl J Med 2005; 353: 663–70.
40. Corpus RA, George PB, House JA et al. Optimal glycemic control is associated with a lower rate of target vessel revascularization in treated type II diabetic patients undergoing elective percutaneous coronary intervention. J Am Coll Cardiol 2004; 43: 8–14.
41. Волкова Е.А., Ворохобина Н.В., Малыгина О.Ф. Модификация образа жизни, обучение и самоконтроль – важные компоненты лечения сахарного диабета и улучшения качества жизни пациентов. Consilium Medicum. 2015; 17 (1): 54–62. / Volkova E.A., Vorokhobina N.V., Malygina O.F. Modifikatsiia obraza zhizni, obuchenie i samokontrol' – vazhnye komponenty lecheniia sakharnogo diabeta i uluchsheniia kachestva zhizni patsientov. Consilium Medicum. 2015; 17 (1): 54–62. [in Russian]
42. Caswell M, Frank J, Viggiani MT et al. Accuracy and user performance evaluation of a blood glucose monitoring system. Diabetes Technol Ther 2015; 17 (3): 152–8.
43. Редькин Ю.А., Богомолов В.В., Древаль А.В. Влияние различных факторов на эффективность самоконтроля при сахарном диабете. Consilium Medicum. 2011; 13 (12): 54–7. / Red'kin Iu.A., Bogomolov V.V., Dreval' A.V. Vliianie razlichnykh faktorov na effektivnost' samokontrolia pri sakharnom diabete. Consilium Medicum. 2011; 13 (12): 54–7. [in Russian]
44. Dunne N, Viggiani MT, Pardo S et al. Accuracy Evaluation of CONTOUR®PLUS Compared With Four Blood Glucose Monitoring Systems. Diabetes Ther 2015; 6 (3): 377–88.
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1. Hurst RT, Lee RW. Increased incidence of coronary atherosclerosis in type 2 diabetes mellitus: mechanisms and management. Ann Intern Med 2003; 139: 824–34.
2. Kip KE, Faxon DP, Detre KM et al. Coronary angioplasty in diabetic patients. The National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. Circulation1996; 94: 1818–25.
3. 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.
4. Stamler J, Vaccaro O, Neaton JD et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care1993; 16: 434–44.
5. Alderman EL, Corley SD, Fisher LD et al. Five-year angiographic follow-up of factors associated with progression of coronary artery disease in the Coronary Artery Surgery Study (CASS). J Am Coll Cardiol 1993; 22: 1141–54.
6. Diabetes Control and Complications Trial (DCCT) Research Group. Effect of intensive diabetes management on macrovascular events and risk factors in the diabetes control and complications trial. Am J Cardiol 1995; 75: 894–903.
7. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet 1998; 352: 837–53.
8. The 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 (9733): 2215–22.
9. Laakso M. Hyperglycemia and cardiovascular disease in type 2 diabetes. Diabetes 1999; 48: 937–42.
10. Wannamethee SG, Shaper AG, Lennon L. Cardiovascular disease incidence and mortality in older men with diabetes and in men with coronary heart disease. Heart 2004; 90: 1398–403.
11. Fisher M. Diabetes: can we stop the time bomb? Heart 2003; 89 (Suppl. 2): 28–30.
12. Akchurin R.S., Vlasova E.E., Mershin K.V. Sakharnyi diabet i khirurgicheskoe lechenie ishemicheskoi bolezni serdtsa. Vestn. RAMN. 2012; 1: 14–9. [in Russian]
13. Dedov I.I. Diabet kak faktor riska serdechno-sosudistykh zabolevanii. Serdechnaia nedostatochnost'. 2003; 3: 16–9. [in Russian]
14. Soinio M, Marniemi J, Laakso M et al. High-sensitivity C-reactive protein and coronary heart disease mortality in patients with type 2 diabetes. A 7-year follow-up study. Diabetes Care 2006; 29 (2): 329–33.
15. Torshkhoeva Kh.N., Tkacheva O.N., Podprugina N.G. i dr. Diabeticheskaia kardiovaskuliarnaia avtonomnaia neiropatiia. Sakharnyi diabet. 2004; 1: 38–9. [in Russian]
16. Radermecker RP, Philips JC, Jandrain B et al. Blood glucose control and cardiovascular disease in patiens with type 2 diabetes. Results of ACCORD, ADVANCE and VA-Diabetes trials. Rev Med Liege 2008; 63 (7–8): 511–8.
17. Dluhy RG, McMahon GT. Intensive glycemic control in the ACCORD and ADVANCE trials. N Engl J Med 2008; 358 (24): 2630–3.
18. LeRoith D, Fonseca V, Vinik A. Metabolic memory in diabetes – focus on insulin. Diabetes Metab Res Rev 2005; 21 (2): 85–90.
19. Mick MJ, Piedmonte MR, Arnold AM et al. Risk stratification for long-term outcome after elective coronary angioplasty: a multivariate analysis of 5,000 patients. J Am Coll Cardiol 1994; 24: 74–80.
20. The BARI Investigators. The Final 10-Year Follow-Up Results Fr om the BARI Randomized Trial. J Am Coll Cardiol 2007; 49: 1600–6.
21. Mathew V, Gersh BJ, Williams BA et al. Outcomes in patients with diabetes mellitus undergoing percutaneous coronary intervention in the current era: a report from the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial. Circulation 2004; 109: 476–80.
22. West NE, Ruygrok PN, Disco CM et al. Clinical and angiographic predictors of restenosis after stent deployment in diabetic patients. Circulation 2004; 109: 867–73.
23. Mazeika P, Prasad N, Bui S et al. Predictors of angiographic restenosis after coronary intervention in patients with diabetes mellitus. Am Heart J 2003; 145: 1013–21.
24. Holmes DR Jr, Leon MB, Moses JW et al. Analysis of 1-year clinical outcomes in the SIRIUS trial: a randomized trial of a sirolimus-eluting stent versus a standard stent in patients at high risk for coronary restenosis. Circulation 2004; 109: 634–40.
25. Byrne RA, Joner M, Kastrati A. Stent thrombosis and restenosis: what have we learned and wh ere are we going. Eur Heart J 2015; 36 (47): 3320–31.
26. Legrand V. Therapy insight: Diabetes and drug-eluting stents. Nat Clin Pract Cardiovasc Med 2007; 4: 143–50.
27. Fröbert O, Lagerqvist B, Carlsson J et al. Differences in restenosis rate with different drug-eluting stents in patients with and without diabetes mellitus: a report from the SCAAR (Swedish Angiography and Angioplasty Registry). J Am Coll Cardiol 2009; 53 (18): 1660–7.
28. Hong SJ, Kim MH, Ahn TH et al. Multiple predictors of coronary restenosis after drug-eluting stent implantation in patients with diabetes. Heart 2006; 92: 1119–24.
29. Svedman C, Ekqvist S, Moller H et al. A correlation found between contact allergy to stent material and restenosis of the coronary arteries. Contact Dermatitis 2009; 60: 158–64.
30. Berezovskaia G.A., Ganiukov V.I., Karpenko M.A. Restenoz i tromboz vnutri stenta: patogeneticheskie mekhanizmy razvitiia i prognosticheskie markery. Ros. kardiol. zhurn. 2012; 6 (98): 91–5. [in Russian]
31. Tian F, Chen Y, Liu H et al. Assessment of characteristics of neointimal hyperplasia after drug-eluting stent implantation in patients with diabetes mellitus: an optical coherence tomography analysis. Cardiology 2014; 128 (1): 34–40.
32. Lomonosova A.A., Grigorova S.Iu., Afanas'ev Iu.I. Problema restenoza posle chreskozhnykh vnutrikoronarnykh vmeshatel'stv i perspektivy ego profilaktiki s pomoshch'iu genoterapevticheskikh vozdeistvii. Nauch. vedomosti. 2010; 4 (75; Vyp. 9). [in Russian]
33. Aronson D, Bloomgarden Z, Rayfield EJ. Potential mechanisms promoting restenosis in diabetic patients. J Am Coll Cardiol 1996; 27: 528–35.
34. Kereiakes DJ, Young JJ. Percutaneous coronary revascularization of diabetic patients in the era of drug-eluting stents. Rev Cardiovasc Med 2005; 6 (Suppl. 1): S48–58.
35. Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA 2002; 287: 2570–81.
36. Sobel BE. Increased plasminogen activator inhibitor-1 and vasculopathy: a reconcilable paradox. Circulation 1999; 99: 2496–8.
37. Yusuf S, Zhao F, Mehta SR et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345: 494–502.
38. Choi D, Kim SK, Choi SH et al. Preventative effects of rosiglitazone on restenosis after coronary stent implantation in patients with type 2 diabetes. Diabetes Care 2004; 27: 2654–60.
39. Dibra A, Kastrati A, Mehilli J et al. Paclitaxel-eluting or sirolimus-eluting stents to prevent restenosis in diabetic patients. N Engl J Med 2005; 353: 663–70.
40. Corpus RA, George PB, House JA et al. Optimal glycemic control is associated with a lower rate of target vessel revascularization in treated type II diabetic patients undergoing elective percutaneous coronary intervention. J Am Coll Cardiol 2004; 43: 8–14.
41. Volkova E.A., Vorokhobina N.V., Malygina O.F. Modifikatsiia obraza zhizni, obuchenie i samokontrol' – vazhnye komponenty lecheniia sakharnogo diabeta i uluchsheniia kachestva zhizni patsientov. Consilium Medicum. 2015; 17 (1): 54–62. [in Russian]
42. Caswell M, Frank J, Viggiani MT et al. Accuracy and user performance evaluation of a blood glucose monitoring system. Diabetes Technol Ther 2015; 17 (3): 152–8.
43. Red'kin Iu.A., Bogomolov V.V., Dreval' A.V. Vliianie razlichnykh faktorov na effektivnost' samokontrolia pri sakharnom diabete. Consilium Medicum. 2011; 13 (12): 54–7. [in Russian]
44. Dunne N, Viggiani MT, Pardo S et al. Accuracy Evaluation of CONTOUR®PLUS Compared With Four Blood Glucose Monitoring Systems. Diabetes Ther 2015; 6 (3): 377–88.
45. Ametov A.S., Chernikova N.A. Glikemicheskii kontrol' u patsientov s sakharnym diabetom tipa 2. Consilium Medicum. 2016; 18 (4): 24–7. [in Russian]
Авторы
В.В.Салухов*, С.В.Кадин, А.Ф.Аглиуллин
ФГБВОУ ВО Военно-медицинская академия им. С.М.Кирова Минобороны России. 194044, Россия, Санкт-Петербург, ул. Академика Лебедева, д. 6
*vlasaluk@yandex.ru
________________________________________________
V.V.Salukhov*, S.V.Kadin, A.F.Agliullin
S.M.Kirov Medical Military Academy of the Ministry of Defence of the Russian Federation. 194044, Russian Federation, Saint Petersburg, ul. Akademika Lebedeva, d. 6
*vlasaluk@yandex.ru