Diabetes mellitus and chronic coronary syndrome

Chronic coronary syndrome is characterized by the development of episodes of ischemia due to an imbalance between needs and blood supply to the myocardium. Such episodes are usual­ly provoked by physical or emotional stress or other stressful situations, but can also occur spontaneously. Angina attacks are a classic manifestation of myocardial ischemia. In some cases, the disease may be asymptomatic for a while and begin immediately with acute coronary syndrome. Chronic coronary syndrome may have a long preclinical period on the background of confirmed coronary athe­rosclerosis. This review analyses the relevant data about the current state of the problem of diabetes mellitus and chronic coronary syndrome. In particular, the issues related to the peculiarities of risk assessment, the main factors causing a very high risk of atherosclerotic cardiovascular diseases; classification, the main characteristics of chronic coronary syndrome and its features in diabetes mellitus; diagnosis of chronic coronary syndrome (dosed physical acti­vity — bicycle ergometry, treadmill test, or stress tests; single-photon emission computed tomography, stress echocardiography; stress cardiac magnetic resonance imaging, positron emission tomography ­using radioactive tracers) were considered. Features of conservative therapy for chronic coronary syndrome against the background of diabetes mellitus (prescription of antiplatelet agents, β-adrenergic receptor blockers, calcium channel blockers, nitrates, angiotensin-converting enzyme inhibitors, myocardial cytoprotectors, statins) were analyzed. Treatment of a patient with a combination of diabetes mellitus and chronic coronary syndrome will be successful only if adequate antidiabetic therapy that is safe in terms of hypoglycemia and possible cardiovascular risks, on the one hand, and metabolically neutral antianginal therapy, on the other, is prescribed. Undoubtedly, it is necessary to pay attention to the correction of risk factors for cardiovascular diseases, hypertension and chronic heart failure.