Diabète et Cœur

Type 2 diabetic patients are at high risk of cardiovascular events, which are 2 to 4 times more frequent than in the non-diabetic patients. About 75% of diabetic patients will die of cardiovascular complications. This increased susceptibility is due in addition to diabetes both to the frequently associated classical risk factors, such as hypertension, dyslipidemia and obesity but also to non classical factors, identified more recently (microalbuminuria, dysautonomia, increased thrombogenesis and inflammatory state, for example). The consequences of diabetes and the associated comorbidities for the heart are coronary artery disease which is more frequent, extensive and occurs earlier, diastolic and less often systolic ventricular dysfunction and left ventricular hypertrophy. The therapeutic approach of the diabetic patient has considerably changed during the last 10 years. Intervention studies have clearly shown that diabetic patients had considerable benefits from treatments directed to improve metabolic control, blood pressure and blood lipid levels not only in the prevention and progression of micro-angiopathic but also of macro-angiopathic complications. Recent studies have even demonstrated that therapeutic targets should be more ambitions in diabetic patients (BP<130/85 mm Hg, total cholesterol <5 mmol/l, LDL-cholesterol <3 mmol/l total cholesterol/HDL-cholesterol <5) because their benefits are more pronounced than in the non-diabetic population. Improving the prognosis of the diabetic patients thus implies an aggressive therapeutic approach on the risk factors and the early recognition of their cardiovascular consequences, most notably coronary artery disease.