[A prospective study on trimetazidine effectiveness and tolerability in diabetic patients in association to the previous treatment of their coronary disease. DIETRIC study]. / Estudio prospectivo en pacientes diabéticos de la efectividad y la tolerabilidad de la trimetazidina en asociación al tratamiento previo de su enfermedad coronaria. Estudio DIETRIC.

INTRODUCTION AND OBJECTIVES: Diabetics frequently suffer diffuse coronary disease with difficulties for coronary artery bypass graft, which means that they require multiple medical treatment. Trimetazidine is an anti-ischemic agent that improves the myocardial metabolism and that can be especially useful in the ischemic myocardium of diabetic patients. The objective of this study is to evaluate in diabetic patients the anti-ischemic effectiveness of trimetazidine associated with regular medical treatment. METHODS: In the DIETRIC study 580 patients with diabetes type 2 and coronary disease have been included for the assessment of antianginous effect of trimetazidine (20 mg/8 h). Basal clinical record, physical examination, laboratory evaluation, ECG and exercise test were carried out, with 6-month follow-up. In this article the clinical and exercise test response to the treatment is analyzed. RESULTS: A reduction of angina episodes was observed (2.8 vs 0,9; p < 0.001), in addition to a reduction of the number of weekly nitroglycerin tablets (2.5 vs 0,7; p < 0.001). In the exercise test carried out at 6-month follow-up an increase in its length was observed (441 vs 391 s; p < 0.001); also an increase of the time up to the decline of ST segment (214 vs 209 s; p = 0.02); at the same time a smaller decline of ST segment occurred (1.7 vs 1,2; p < 0.001). Tolerance was excellent. CONCLUSIONS: In this group of patients with diabetes mellitus type 2 and coronary artery disease, trimetazidine associated with regular medical treatment decreased the incidence of angina episodes and the ischemic response in the exercise test with an excellent tolerance.

[Limited application of prevention measures in patients with diabetes mellitus type 2 and coronary artery disease in Spain. DIETRIC study]. / Escasa aplicación de las medidas de prevención en los pacientes con diabetes mellitus tipo 2 y enfermedad arterial coronaria en España. Estudio DIETRIC.

INTRODUCTION AND OBJECTIVES: Diabetes is a disease with high prevalence that involves high mortality. The control of risk factors reduces the cardiovascular complications. The objective of this study is to define the control degree of cardiovascular risk factors in patients with diabetes and coronary artery disease. METHODS: In DIETRIC study 628 patients with diabetes type 2 and coronary artery disease have been included with the aim to study the antianginous effect of trimetazidine. Patients were studied basally with clinical history, physical exploration, laboratory testing, ECG and exercise test, with 6-month follow-up. In this article the profile of cardiovascular risk and the level of control of the risk factors in the basal study are analyzed. RESULTS: More than 80% of patients showed excess weight or obesity, 73% dyslipemia and 59% hypertension. More than 60% of patients showed 3 or more related risk factors. Only 15% had adequate control of blood pressure, and the control of diastolic pressure (55%) was most frequent than that of systolic (17%). Only 7.5% had adequate control of plasma lipids. Many patients did not take drugs to reduce mortality, as aspirin and statins. CONCLUSIONS: Most of these diabetic patients with coronary artery disease do not have adequate control of risk factors. A limited use of drugs that have proven to reduce cardiovascular mortality in these patients is observed.

[An adrenaline-induced vasospasm as the form of presentation of variant angina]. / Vasoespasmo inducido por adrenalina como forma de presentación de una angina variante.

A 41-year-old-man without previous ischemic heart disease, developed a severe anaphylactic reaction. After administration of epinephrine (0.5 mg) the patient complained of chest pain. The electrocardiogram showed an elevation of ST segment in inferior leads. Myocardial necrosis was ruled out. Coronary arteriography disclosed normal coronary arteries. Eight months later, the patient developed severe chest pain during physical activity. ST elevation was again seen in inferior leads. ECG changes disappeared, when sublingual nitroglycerin was administered. A diagnosis of vasospastic angina was made. Exercise test was negative, during treatment with calcium-blocking agents. The patient subsequently remain free of symptoms taking medication. The physiological mechanisms of vasospastic angina and precipitating factors are discussed.

[Heart transplantation in a patient with rheumatoid arthritis]. / Trasplante cardíaco en un paciente con artritis reumatoide.

A 56 year-old woman with rheumatoid arthritis was diagnosed with idiopathic dilated cardiomyopathy. She developed progressive heart failure that was refractory to conventional medical management. Heart transplantation was performed bearing in mind the controversy that surrounds its use in patients with a systemic disease. Transplant and rheumatoid arthritis were favorable at 33 month evolution. The immunosuppressive therapy required for the transplant helped the control of her articular disease.