New opportunities for prognosis improvement in chronic ischaemic heart disease and diabetes mellitus patients

• Pavlova Tatyana V.
• Duplyakova P.D.

Abstract

Modern epidemiological studies indicate that in every second case of ischaemic heart disease (IHD) concomitant diabetes mellitus can also be diagnosed. This affects negatively the life expectancy and increase risk of cardiovascular complications development and death. Modern approaches to management of patients with diabetes mellitus and established diagnosis of ischaemic heart disease are aimed at reducing risk of adverse cardiovascular events, however, up to 10% of patients with stable IHD annually suffer from acute exacerbation of a chronic disease. Combination of peripheral arterial disease and diabetes mellitus increases risk of lower limb amputations by more than five times. Modern versions of clinical practice guidelines for management of patients of this profile until recently limited antithrombotic therapy by using drugs with antiplatelet action (mainly acetylsalicinic acid). In 2019 ESC Guidelines the management strategy for patients with chronic coronary syndrome was revised. For secondary prevention in group of high-risk patients addition of a second antithrombotic drug complementary to aspirin is recommended with level IIaA recommendations, and for patients at moderate risk - with level IIbA recommendations [1].

In the COMPASS study proportion of patients with diabetes mellitus in patient population with chronic IHD was 37%. The subanalysis performed in this subgroup of patients showed superior efficacy of combination therapy with Rivaroxaban 2.5 mg/2 times/day and acetylsalicylic acid in patients with stable atherosclerosis compared with monotherapy with acetylsalicylic acid. The efficacy and safety profile of combination therapy in the COMPASS study in patients with stable course of atherosclerosis and concomitant diseases is comparable with results obtained in the main population of this study.

Keywords:ischaemic heart disease, diabetes mellitus, chronic kidney disease, rivaroxaban

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