Risk factor control and medical therapy of coronary artery disease in Taiwan - Review and Recommendations - Part III: Blood sugar management for patients with coronary artery disease

Yen-Wen Wu ； Jaw-Wen Chen

《海峽循環醫學雜誌》 1卷3期 (2019/11) Pp. 14-16

https://doi.org/10.6907/SCJ.201911_1(3).0003

摘要

Cardiovascular disease (CVD) is the leading cause of death in the world and the second important cause of death in Taiwan. Atherosclerosis CVD (ASCVD) especially coronary artery disease (CAD) is the major cause of CVD [1]. Clinically, the presentation of CAD can be divided into acute unstable disease, so-called acute coronary syndrome (ACS) and chronic stable disease. Up to now, the main risk factors for CAD are known as hyperlipidemia, hypertension, hyperglycemia, smoking and family history. The control of the above risk factors and lifestyle modifications can improve the prognosis of CAD patients [1,2]. Here, we described the blood lipid control, blood pressure control, blood glucose control, and lifestyle modifications for CAD in Taiwan. The followings are the part III for blood glucose control. Type 2 Diabetes mellitus (T2DM) has been suggested a CAD equivalent. The risk of CAD may be correlated with the baseline HbA1c. Numerous studies have demonstrated the benefits of controlling modifiable CV risk factors in people with diabetes. Therefore, in patients with documented CAD, DM control is recommended.Because the benefits of intensive glucose control emerge slowly, while the harms can be immediate, people with longer life expectancy have more to gain from intensive glucose control. The 4 randomized clinical trials (RCTs), including UKPDS, ACCORD, ADVANCE, VADT trials, or large meta-analyses, testing intensive glucose control vs. conventional glucose control did not show positive results in reducing major adverse cardiovascular events (MACE) in individual trials. There are also lack of HbA1c target CV outcome trials in patients with CAD. The impact of glucose control on macrovascular complications is less certain. In the consensus, glycemic treatment targets should be individualized based on patient characteristic, including frailty and comorbid conditions, and risk of adverse effects of therapy (e.g., hypoglycemia and weight gain), to balance the benefit and risks of glycemic control, rather than the strengthen the HbA1c target in patients with documented CAD.