Treatment of Diabetes Mellitus to Prevent Cardiovascular Disease

  Ischemic heart disease such as acute myocardial infarction among cardiovascular diseases is one of the leading causes of morbidity and mortality. Diabetes mellitus is one of the major risk factors for ischemic heart diseases, especially for myocardial infarction. It has been reported that the rate of new onset of myocardial infarction is 5.7 times higher and the rate of recurrence is 2.4 times higher in patients with diabetes mellitus than in those of normal subjects (Finnish study). Therefore, the target of treatment of diabetes mellitus should be the reduction of morbidity of ischemic heart disease such as myocardial infarction. However, it has been reported that to lower the HbA1C level leads to the reduction of rate of micovascular disease, but does not always reduce the rate of large vascular diseases such as myocardial infarction (UKPDS). Furthermore, postprandial glucose levels rather than fasting glucose levels have been reported to be associated with cardiovascular disease (Funagata study). Therefore, what is most important in the treatment of diabetes mellitus is to reduce the morbidity of acute myocardial infarction by preventing the development of atherosclerosis and stabilizing the plaques of coronary artery. Furthermore, even in case acute myocardial infarction may occur, use of anti-diabetic drugs with pharmacological preconditioning effect to reduce the myocardial infarct size is also an important point. In this symposium, treatment of diabetes mellitus aiming at prevention of acute myocardial infarction will be discussed from basic science to clinical application including novel advanced strategy for the treatment.