åêðáéäåõóçó γ.ν.α.

488
Ποιοί ασθενείς με Σακχαρώδη Διαβήτη
Τύπου 2 θα πρέπει να υποβάλλονται
σε προληπτικό έλεγχο για στεφανιαία νόσο;
Σ Κουλούρης
SUMMARY
Koulouris S. Coronary artery disease in patients with type 2 diabetes mellitus. Who is the
appropriate candidate for screening test Coronary artery disease is responsible for 65-80% of
deaths in diabetic patients, while type 2 diabetes mellitus is one of the most important risk factors
for the development of atherosclerosis. Early diagnosis of coronary artery disease, prior to the development
of any symptoms, could potentially lead to early therapeutic interventions, therefore to
improved quality of life, and increased survival in diabetic patients. However, current evidence is not
supportive of a massive screening strategy for silent ischemia in type 2 diabetes, since even the presence
of other cardiovascular risk factors has proven to be of low predictive value. Moreover, since all
current guidelines suggest an intensive treatment of risk factors, the “treat without test” policy may
be the appropriate one for this particular population. Based on the above, the American Diabetes
Association suggest further testing only for those with typical or atypical cardiac symptoms or with an
abnormal resting electrocardiogram. For asymptomatic patients coronary calcium score, as assessed
with computed tomography, could possibly used as a first choice screening test in the individual
patient with high clinical suspicion of myocardial ischemia. The results of ongoing multi-center trials
will help us to clarify the efficacy of newer revascularization techniques in diabetic patients. This will
permit the selection of those high-risk patients who could possibly benefit from an early diagnosis and
an interventional therapeutic approach. Beyond that, further research for the development of new
risk prediction models incorporating data from the modern diagnostic techniques, is an important
and promising task. Nosokomiaka Chronika, 71, Supplement, 488-494, 2009.
xxxxxxxxx
xxxxxxxxxxxx
xxxxxxxxxxxx
Key words: Αtherosclerosis, early diagnosis, diabetes mellitus, myocardial ischemia.
ΠΕΡΙΛΗΨΗ
Η στεφανιαία νόσος ευθύνεται για το 65-80% των θανάτων στους διαβητικούς ασθενείς,
ενώ ο σακχαρώδης διαβήτης τύπου 2 αποτελεί έναν από τους σημαντικότερους παράγοντες
κινδύνου για την ανάπτυξη αθηρωματικής νόσου. Η πρώιμη διάγνωση της στεφανιαίας
νόσου πριν από την εμφάνιση συμπτωμάτων, θα οδηγούσε ενδεχομένως σε βελτίωση της
ποιότητας ζωής και σε αύξηση της επιβίωσης των πασχόντων από σακχαρώδη διαβήτη.
Εντούτοις, τα δεδομένα που υπάρχουν μέχρι στιγμής δεν ευνοούν μια στρατηγική μαζικού
Επιμελητής Α ΄, Α ΄ Καρδιολογικό Τμήμα, ΓΝΑ «Ο Ευαγγελισμός»