Abstract
IntroductionThe prevalence of diabetes is increasing rapidly, and individuals with diabetes are at high risk for cardiovascular disorders. Subsequently the percentage of patients with diabetes subjected to revascularisation, i.e. either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) also rises rapidly. The outcome of patients with diabetes after PCI is worse than for patients without diabetes. Restenosis is the main limiting factor of the long-term success of PCI. Although stents and antithrombotics improved outcome after PCI in both diabetics and non-diabetics, diabetics still have a worse prognosis. This leads to the suggestion that the restenosis mechanism in diabetics might be different from that in non-diabetics.ConclusionSeveral glucose lowering agents have been shown to influence the restenosis process and thus the outcome after PCI. Current data of especially metformin and thiazolidinediones indicate beneficial results as compared to insulin and sulfonylurea on restenosis. However, no large trials have been undertaken in which the effect of glucose lowering agents on restenosis is associated with improved outcome.The purpose of this review is to summarize the effect of diabetes and glucose lowering agents on restenosis.
Highlights
The prevalence of diabetes is increasing rapidly, and individuals with diabetes are at high risk for cardiovascular disorders
No large trials have been undertaken in which the effect of glucose lowering agents on restenosis is associated with improved outcome
The purpose of this review is to summarize the effect of diabetes and glucose lowering agents on restenosis
Summary
Diabetes is a major risk factor for adverse events after PCI. Diabetics have higher rates of mortality, myocardial infarction and target vessel revascularisation than non-diabetics. Recent therapeutical antithrombotic and percutaneous developments improved the prognosis both for diabetics and non-diabetics, thereby maintaining a worse prognosis for diabetics. Several glucose lowering drugs influence the restenosis process. The prognosis of diabetics undergoing PCI remains worse than non-diabetics. The best way to improve the prognosis of diabetics undergoing PCI is to prevent diabetes or to pursue adequate diabetes regulation. Future area of interest Due to the negative influence of diabetes on prognosis after PCI, glucose lowering therapy might have a substantial influence on coronary restenosis and the worse prognosis of diabetics.
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