Updated May 18, 2006

Angina

Pain or tightness in the chest, a symptom of coronary heart disease (CHD). People with diabetes are at increased risk for CHD, a condition in which the heart muscle does not get a sufficient supply of blood, oxygen, and nutrients to meet its needs because of partial or complete blockage of the coronary blood vessels. This is usually due to atherosclerosis, the buildup of plaque (fatty deposits) on artery walls in the coronary vessels that feed the heart. There are a number of risk factors for CHD, including high blood pressure, diabetes, a family history of CHD, smoking, high cholesterol levels, high triglyceride levels, obesity, and inactivity.

Angina can vary considerably from person to person. It usually takes the form of chest pain that comes on gradually over a period of 30 seconds to several minutes. In some cases it may become more severe; in others it may remain mild and go away. The pain may also affect the left arm, shoulder, armpit, neck, or jaw. It may be brought on by exercise or emotional stress, but it may also occur at rest. Sometimes angina may produce symptoms of nausea and upper abdominal discomfort, when it can be mistaken for heartburn.

Two different types of drugs are commonly used to treat angina. Coronary vasodilators (such as nitroglycerin) cause the vessels of the heart to relax and widen, allowing for improved blood flow. Blood-pressure-lowering drugs can decrease the heart's workload and need for oxygen.

Another method for restoring blood flow to the heart is percutaneous transluminal coronary angioplasty (PTCA), also known as balloon angioplasty. In this method, a special balloon at the end of a catheter is threaded up to the site of arterial blockage, inflated to compress the plaque, and then withdrawn. This procedure enlarges the inner diameter of the blood vessel to allow for greater blood flow. In many cases, a stent (a small metal device in the shape of a spring or mesh cylinder) is placed in the vessel to keep it open. There is evidence that angioplasty may not be an optimal choice in people with diabetes, because their coronary vessels tend to abruptly close again following angioplasty.

Another technique is coronary artery bypass grafting (CABG), in which a blood vessel from another part of the body (usually the leg or inside the chest wall) is used to form a detour around the blocked part of the coronary artery. Studies have shown that in people with diabetes, CABG is much more effective than balloon angioplasty over the long term.

There are a number of preventive measures you and your doctor can take to lower your risk of developing angina and CHD:

• If you smoke, stop!
• Follow a diet that is low in cholesterol, saturated fat, and salt, as recommended by a dietitian. This can help control high cholesterol levels and high blood pressure, both of which are risk factors for coronary heart disease.
• Exercise regularly. This can help you maintain your weight and lower your blood pressure. (People with diabetes are advised to consult their doctor before embarking on an exercise program.)
• If proper diet and exercise aren't enough to sufficiently lower your cholesterol levels or blood pressure, there are a number of very effective cholesterol-lowering and blood-pressure-lowering drugs available.
• Keep your blood glucose within goal range.

This article was written by Robert S. Dinsmoor, a Contributing Editor of Diabetes Self-Management.

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