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A Journal on Endocrine System Diseases

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Minerva Endocrinologica 2009 September;34(3):205-21

language: English

Cardiovascular risk stratification of diabetic patients

Cuocolo A. 1,2, Concilio C. 3, Acampa W. 1,2, Ferro A. 1,2, Evangelista L. 3, Daniele S. 3, Petretta M. 4

1 Department of Biomorphological and Functional Sciences, University Federico II, Naples, Italy;
2 Institute of Biostructures and Bioimages of the National Council of Research Naples, Italy;
3 SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy;
4 Department of Clinical Medicine, Cardiovascular and Immunological Sciences University Federico II, Naples, Italy


Diabetes mellitus is a complex clinical entity that will grow in importance in the future. The complications of diabetes have a significant impact on patient survival and quality of life, particularly with respect to coronary artery disease (CAD). Appropriate screening and aggressive intervention can significantly benefit many patients with diabetes. In addition, it is important to consider strategies useful not only in the diagnosis of CAD but also in the prognostic evaluation of diabetic patients with coronary disease. Prognostic data are essential in defining risk categories and to apply appropriate treatment for the degree of risk. Therefore, accurate cardiovascular risk stratification of patients with type 2 diabetes is required. However, this can be a problematic issue because the clinical presentation and progression of CAD differs between diabetic and nondiabetic subjects. In addition to a higher prevalence of CAD, patients with diabetes experience more diffuse and extensive coronary artery involvement, more often have left ventricular dysfunction, a more advanced coronary disease at the time of diagnosis, and more often experience silent ischemia. Furthermore, diabetic patients have frequently a less favorable response to revascularization procedures and a poorer long-term outcome. The purpose of this review is to discuss the relative role of various procedures for diagnosis of CAD and for cardiac risk stratification in patients with diabetes.

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