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Percutaneous coronary intervention in diabetics: time to consider “intimal remodelling therapy”?
  1. P F Ludman
  1. Correspondence to:
    Dr Peter F Ludman, Cardiology Department, Queen Elizabeth Hospital, University of Birmingham, Edgbaston, Birmingham B15 2TH, UK;
    p.f.ludman{at}bham.ac.uk

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Can “intimal remodelling therapy” by percutaneous coronary intervention improve the otherwise poor prognosis of diabetic patients with severe diffuse multivessel disease?

An apparently inexorable sequence of remarkable developments in the techniques of percutaneous coronary intervention (PCI) have led to this method being poised to become the dominant tool for coronary revascularisation. Nevertheless, interventional cardiologists will not be able to make this claim until we can be confident about the best management strategy for patients with diabetes and multivessel coronary disease.

Diabetes is a vascular disease. Patients with both type 1 and type 2 diabetes carry the burden of a high incidence of premature fatal macrovascular disease. Type 2 diabetes, best described as a cluster of risk factors for cardiovascular disease (insulin resistance, dyslipidaemia, obesity, hypertension) is associated with a reduction in life expectancy of 8–10 years in the 40–70 year age range.1 Type 1 diabetes is rather different. It is not associated with other classical cardiovascular risk factors. Indeed the normal or low triglyceride concentrations, normal or high HDL (high density lipoprotein) cholesterol and normal LDL (low density lipoprotein) cholesterol should be protective. Nevertheless, type 1 diabetes carries the same disturbingly high rate of cardiovascular disease. The standardised mortality ratio for men and women aged 40–59 years is 4.7 and 7.8, respectively.2 Type 2 diabetes accounts for more than 95% of all diabetes, and its prevalence is rising at an alarming rate. In 2001 it was estimated that over 150 million people in the world were diabetic. Because of a sharp rise in prevalence over the last decade, it is predicted that by 2010 the global prevalence of diabetes will be in excess of 220 million.3 Against this backdrop is a series of studies that have consistently failed to show any significant reduction in fatal cardiovascular disease …

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