[Treatment of coronary insufficiency in diabetics. Part 1: objectives and targets].

Coronary insufficiency affects 55% of insulin-dependant diabetics and is responsible for 60% of deaths in this population. Its particular severity is essentially due to the severity of coronary atherosclerosis, which is usually multi-vessel, involves both large trunks and microcirculation, is made of frequently lipid-rich and therefore fragile plaques, and is accompanied by abnormal but specific reactions of the arterial wall (tendency to vasoconstriction and increased neointimal proliferation after trauma). Coronary atherosclerosis is also often associated with HT, lower limb arteriopathy or cerebral atherosclerosis. Quality of blood glucose control, other organic lesions of diabetes (nephropathy, retinopathy), disturbances of platelet function and dyslipidaemias (hypercholesterolaemia, hypertriglyceridaemia, increased levels of highly atherogenic small LDL particles) are also involved in the development of coronary insufficiency. A precise knowledge of the diseases to be treated and their particularly rigorous prevention and treatment can improve the prognosis of coronary insufficiency in diabetics.