Approaches to antianginal therapy selection in patients with diabetes mellitus type 2
I.S. MYKHAILICHENKO1, V.A. BAGRIY2, A.YU. ANDRUSYAK1, I.A. GOLODNIKOV1
1M. Gorky Donetsk National Medical University, Donetsk, Donetsk People’s Republic
2Central City Clinical Hospital No. 1, Donetsk, Donetsk People’s Republic
Contact details:
Mykhailichenko I.S. — PhD (medicine), Assistant Lecturer of the Department of Department of Internal Diseases No. 2
Address: 16 Illicha Ave., Donetsk, Donetsk People’s Republic. 283003, tel.: +38 (071) 470-68-08, e-mail: klassiki@inbox.ru
The purpose — to study the efficacy and tolerability of different classes of antianginal drugs in patients with chronic coronary artery disease with DM2 having stable angina pectoris syndrome.
Material and methods. 104 patients (m/w 59/45, average age — 64.7 (11.1) years) with DM2 and with stable angina pectoris were under observation. All patients received adequate hypoglycemic, vaso- and cardioprotective therapy. All patients were prescribed antianginal agents in various combinations: β-AB — in 32 (30.8%) cases, calcium channel blockers — in 30 (28.8%), ivabradine — in 29 (27.9%), ranolazine — in 25 (24.0%), nitrates — in 22 (21.2%), trimetazidine — in 38 (36.5%), and meldonium — in 34 (32.7%) cases. Before the start of follow-up and after 16 weeks of treatment the angina pectoris class and standard clinical and biochemical parameters were evaluated, echocardiographic examination, Holter monitoring of an electrocardiogram, a test with reactive hyperemia were performed.
Results. The treatment provided a rapid, distinct and stable antianginal effect. Thus, the average levels of angina pectoris decreased from 2.37 (0.4) to 1.19 (0.1), p < 0.05. A significant decrease in clinical manifestations of angina pectoris was achieved after 2 weeks from the start of treatment in 72 (69.2%), and after 4 weeks — in 93 (89.4%) people. A reliable relationship between the higher antianginal efficacy of treatment and some clinical and laboratory features of patients was revealed.
Conclusions. In individuals with stable angina and DM2, adequate use of antianginal drugs provides a rapid and stable decrease in the severity of angina.
Key words: angina pectoris, diabetes mellitus, antianginal therapy, treatment.
REFERENCES
- American Diabetes Association. 10. Cardiovascular disease and risk management: Standards of Medical Care in Diabetes2020. Diabetes Care, 2020, vol. 43, suppl.1, pp. S111–S134. DOI: 10.2337/dc20-s010
- Arnold S.V., Bhatt D.L., Barsness G.W. et al. Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association. Circulation, 2020, vol. 141, pp. e779–e806. DOI: 10.1161/CIR.0000000000000766
- Cosentino F., Aboyans V., Bailey C.J. et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). European Heart Journal, 2020, vol. 41 (2), pp. 255–323. DOI: 10.1093/eurheartj/ehz486
- Arnett D.K., Blumenthal R.S., Albert M.A. et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2019, vol. 140, pp. e596–e646. DOI: 10.1161/ CIR.0000000000000678
- Dedov I.I., Shestakova M.V., Mayorov A.Yu. et al. Type 2 diabetes mellitus in adults: clinical guidelines. Sakharnyy diabet, 2020, vol. 23, no. S2, pp. 4–102 (in Russ.).
- Knuuti J., Wijns W., Saraste A. et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur. Heart J, 2020, vol. 41, pp. 407–477.
- Mancini G.B.J., Boden W.E., Brooks M.M. et al. Impact of treatment strategies on outcomes in patients with stable coronary artery disease and type 2 diabetes mellitus according to presenting angina severity: a pooled analysis of three federally-funded randomized trials. Atherosclerosis, 2018, vol. 277, pp. 186–194. DOI: 10.1016/j.atherosclerosis.2018.04.005
- Nebieridze D.V. Topical issues of the use of beta-blockers in various clinical situations. Meditsinskiy sovet, 2018, vol. 12, pp. 12–17 (in Russ.). DOI: 10.21518/2079-701X-2018-12-12-17
- Nardotto G.H., Lanchote V.L., Coelho E.B et al. Population pharmacokinetics of carvedilol enantiomers and their metabolites in healthy subjects and type-2 diabetes patients. European Journal of Pharmaceutical Sciences, 2017, vol. 109, pp. S108–S115.
- Kosiborod M., Arnold S.V., Spertus J.A. et al. Evaluation of ranolazine in patients with type 2 diabetes mellitus and chronic stable angina: results from the TERISA randomized clinical trial (Type 2 Diabetes Evalu- ation of Ranolazine in Subjects with Chronic Stable Angina). J Am Coll Cardiol, 2013, vol. 61, pp. 2038–2045. DOI: 10.1016/j.jacc.2013.02.011
- Komajda M., Tavazzi L., Francq B. G. et al. Efficacy and safety of ivabradine in patients with chronic systolic heart failure and diabetes: an analysis from the SHIFT trial. European journal of heart failure, 2015, vol. 17 (12), pp. 1294–1301.
- Meiszterics Z., Kónyi A., Hild G. et al. Effectiveness and safety of anti-ischemic trimetazidine in patients with stable angina pectoris and Type 2 diabetes. Journal of comparative effectiveness research, 2017, vol. 6 (8), pp. 649–657.
- Statsenko M.E., Turkina S.V., Fabritskaya S.V. et al. Efficiency of short-term meldonium therapy in patients with chronic heart failure of ischemic etiology and type 2 diabetes mellitus. Kardiologiya, 2017, vol. 57, no. 4, pp. 58–63 (in Russ.).
- Nedogoda S.V. Meldonium as a supra-nosological drug. Consilium Medicum, 2020, vol. 22, no. 5, pp. 57–61 (in Russ.).