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Heart disease in patients with the diabetic renal-retinal syndrome: clinical considerations

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Diabetic Renal-Retinal Syndrome

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Abstract

Every physician treating diabetic patients knows that the greatest risk of death lies in coronary artery and/or other heart disease. According to the United States Renal Data System, heart disease accounts for the most deaths in ESRD patients treated with peritoneal or hemodialysis or given a kidney transplant. Minimizing morbidity and mortality from heart disease in diabetic patients requires the same strategy that is applicable to the population at large, mainly normalizing blood pressure and Iipid levels. In preparation for a kidney transplant, the question of invasive (angiography) versus noninvasive cardiac testing is of major concern. Clark does not advise angiography because fewer than one-half of subjects will have significant lesions that may benefit from revascularization. Dobutamine echocardiography is the preferred procedure especially in diabetic subjects unable to exercise maximally because of coexisting obesity, peripheral vascular disease, degenerative joint disorders, or peripheral neuropathy. Correction of coronary artery insufficiency may be affected either by angioplasty or bypass surgery. Studies to date suggest that in diabetes, bypass surgery imparts a survival advantage over angioplasty though the authors caution that the addition of coronary artery stenting to angioplasty has been incompletely assessed. We agree that vigilant cardiac monitoring must be continued in stable diabetic ESRD patients who express no symptoms of coronary disease. Only by detection and correction of silent coronary disease will deaths from sudden heart disease be lessened.

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Authors
  1. Luther T. Clark
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Editors and Affiliations

  1. Department of Medicine, State University of New York, Health Science Center at Brooklyn, Brooklyn, NY, USA

    Eli A. Friedman M.D. (Distinguished Teaching Professor) (Distinguished Teaching Professor)

  2. College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Francis A. L’Esperance Jr. M.D. (Clinical Professor of Opthalmology) (Clinical Professor of Opthalmology)

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© 1998 Springer Science+Business Media Dordrecht

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Clark, L.T. (1998). Heart disease in patients with the diabetic renal-retinal syndrome: clinical considerations. In: Friedman, E.A., L’Esperance, F.A. (eds) Diabetic Renal-Retinal Syndrome. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-4962-4_14

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  • DOI: https://doi.org/10.1007/978-94-011-4962-4_14

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-6083-7

  • Online ISBN: 978-94-011-4962-4

  • eBook Packages: Springer Book Archive

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