The patient with unstable angina: no evidence of MI.

A 53-year-old type 2 diabetic woman with macrovascular complications as well as the components of the metabolic syndrome presents with an unstable angina and ST depression on electromiogram. The negative impact of female gender, microvascular complications, and metabolic parameters on cardiovascular risk and prognosis, are emphasized. The lack of evidence for hormone replacement, antioxidant or universal folic acid therapy is underscored. Treatment options including PTCA and stenting augmented with low molecular weight heparin, clopidrogel and IIb/IIIa antagonists as well as optimal metabolic control are discussed.