In the US, approximately 700,000 multivessel coronary revascularization procedures done yearly, and 25% are done on diabetics.
Diabetes is a major risk factor for cardiovascular disease and its prevalence is increasing worldwide.
Patients with type two diabetes have increased mortality, and 80% of the deaths caused by cardiovascular complications, often myocardial infarctions.
Myocardial infarction is the most common cause of death in patients with diabetes.
The Bypass Angioplasty Revascularization Investigation (BARI) trial noted that diabetics with multivessel disease who underwent CABG lived longer than patients undergoing angioplasty.
Studies show a trend toward more frequent adverse cardiovascular and cerebrovascular events in patients with diabetes and multivessel coronary disease who undergo PCI than among those undergoing CABG.
The benefits of CABGs also extend to patients treated with drug eluting stents and contemporary medical therapy (FREEDOM trial investigators).
In diabetic patients with multivessel coronary artery disease, CA BG provide slightly better intermediate term health status and quality of life than PCI using drug eluting stents: these benefits did not persist after two years.
Among patients with diabetes symptoms of coronary artery disease are often absent even with advanced disease.
Diabetic patients hospitalized for a stable angina or on-Q-wave MI have a significantly higher 2 year morbidity and mortality as compared with non-diabetic patients.
Seven year risk of MI is as high in diabetic patients without prior MI as it is in nondiabetic patients with prior MI, establishing diabetes as a cardiovascular disease risk equivalent.
Increased prevalence of cardiovascular disease with type two diabetes is largely attributed to atherosclerotic burden and adverse plaque formation, as well as the inability to compensate for those changes.
Steno-2 trial randomized type two diabetics and microalbuminuria to receiving conventional diabetic treatment to intensified multi factorial treatment: after a median observation period of approximally 21 years, patients in the intensive therapy group survived for a medium of 7.9 years longer than those in th conventional therapy group.
BARI trial (Bypass Angioplasty Revascularization 2Diabetes: Drugs that reduce insulin resistance decrease the risk of cardiovascular disease events compared with drugs that increase insulin levels in patients with type two diabetes and who receive coronary artery revascularization.
In the above study reducing insulin resistance accompanying CABG leads the lowest rate of cardiovascular disease events.
The most important way to prevent T2D and CVD is to promote a healthy lifestyle throughout life.
Adults should engage in at least 150 minutes per week of moderate-intensity or 75 minutes per week of vigorous-intensity physical activity.
All adults should consume a healthy diet rich in vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish.
Along with modifiable risk factor optimization, healthy lifestyle choices protect against the development and worsening of T2D and CVD, as well as the development of CVD among T2D patients.