Being a diabetic and having 'bad genes' puts you at a significantly increased risk for recurrence of coronary artery blockages, heart attacks, stokes, renal disease and peripheral arterial disease. You must have taken good care of your diabetes because it took 27 years for you to develop any complications. You are also fortunate because you underwent bypass surgery and have the artery coming from your breast attached to one of your coronary vessels which has been shown to have a better prognosis in diabetics. The only thing you can do at this point is to minimize your risk factors for progression of your CAD. This means:
1. Be very aggressive with DM management. Keep your sugars, HgB A1C and your weight at goal.
2. Eat well, exercise and don't smoke (second hand smoking is just as bad).
3. Be aggressive with lipid control. Your LDL cholesterol should be less than 70, and your HDL as high as possible. Make sure your triglycerides are well controlled. Being on a statin such as lipitor or zocor or crestor provides benefits beyond lipid lowering in coronary artery disease and stroke.
4. You must be on ASA, beta blockers and statins.
5. Control your blood pressure as best as possible. The lower the better as long as your don't feel dizzy or lightheaded. Typical goal is less than 120/8. But again, the lower the better, especially if you have protein in your urine.
6. You must also be on an ace inhibitor or an angiotensin receptor blocker. They improve survival in your type of patients and post-pone renal dysfunction which portends worse prognosis in patients with CAD.
7. Unfortunately, at this stage of the game, there is nothing that we can do to change your risk related to you family history (bad genes).