Adding Surgery to Meds May Help Diabetics With Heart Disease

TUESDAY Nov. 16, 2010 -- Using surgical procedures to open clogged arteries in addition to standard drug therapy seems to work better at maintaining good blood flow in diabetics with heart disease, new research finds.

The analysis, being presented Tuesday at the American Heart Association's annual meeting in Chicago, is part of a larger randomized clinical trial deciphering how best to treat type 2 diabetics with heart disease.

In that study, the U.S. government-funded BARI 2D, all participants took cholesterol-lowering medications and blood pressure drugs. They were then were randomized either to continue on drugs alone or to undergo a revascularization procedure -- either bypass surgery or angioplasty.

The initial findings showed that patients fared equally well with either treatment strategy.

But this more recent analysis took things a step further and found that there did, in fact, appear to be an added benefit from artery-opening procedures by the end of one year.

More than 1,500 patients who had participated in the original trial underwent an imaging procedure called stress myocardial perfusion SPECT or MPS, which were then analyzed in this study.

"At one year, interestingly, we saw that patients who were randomized to revascularization had significantly less severe and less extensive and less severe myocardial perfusion [blood flow] abnormalities," said study author Leslee J. Shaw, professor of medicine at Emory University School of Medicine in Atlanta.

Shaw reported ties with different pharmaceutical and related companies.

"We also saw trends at this one year test towards greater effectiveness improvements in angina [heart disease-linked chest pain]," she added.

The study found that 59 percent of patients in the surgery arm had no apparent blockage of blood flow compared to 49 percent in the medication-only group.

Those with compromised blood flow (ischemia), not surprisingly, were more likely to have a heart attack or die, the researchers noted.

But, Shaw pointed out, the patients included in this study all had relatively good blood flow overall and were considered low risk for cardiac problems. "It remains to be seen [how the strategies fare] in patients with more extensive and moderate to severe ischemia," Shaw said.

Another trial is now being planned which will look at patients with moderate-to-severe ischemia.

Because this study was presented at a medical meeting, its data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

And one expert not involved in the trial said that the jury is still out on this issue.

Dr. Jeffrey S. Borer, chair of the department of medicine and of cardiovascular medicine at the State University of New York (SUNY) Downstate Medical Center in New York City, noted that the length of time patients were tracked in the study was not very long.

"This study is useful and the data is interesting . . . [but] what we really care about is longer term clinical results," he said.

More information

There's more on diabetes' link to heart disease at the U.S. National Institutes of Health.

Posted: November 2010


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