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Diabetes Study Suggests Heart Medications Work Just As Well As Stents

Posted on: Monday, 8 June 2009, 10:30 CDT

U.S. researchers said on Sunday that diabetics with stable heart disease do just as well taking drugs alone as getting quick angioplasty or bypass surgery to open blocked heart arteries, Reuters reported.

The report said heart patients could safely wait and give drugs a chance to work, rather than immediately undergoing angioplasty and a heart stent to restore blood flow and ease chest pain.

However, it acknowledged that patients with more severe disease sent for more invasive heart bypass surgery might be able to avoid a future heart attack if they have the surgery right away.

Researchers also concluded there was no difference in heart risks between two strategies for treating type 2 diabetes.

The methods involve increasing the amount of insulin or lowering the body's resistance to its own insulin with drugs such as either metformin or GlaxoSmithKline's Avandia, also known as rosiglitazone, which had been linked to increased chance of heart attacks in the past.

Dr. Trevor Orchard of the University of Pittsburgh, whose study appears in the New England Journal of Medicine, said patients that have diabetes and heart disease serious enough to require bypass surgery should have the procedure early rather than delaying it.

The team looked at 2,368 patients who either got treated right away with angioplasty, usually with a stent, and drugs or simply got drug treatment . After five years, they found no difference in the rates of death, heart attack or stroke.

Orchard said the study provides evidence on how best to treat people with both type 2 diabetes and heart disease.

Additionally, the study represents a positive sign for GlaxoSmithKline, suggesting Avandia may be safer than earlier analyses had reported.

However, stent makers such as Boston Scientific Corp and Johnson & Johnson, whose U.S. sales plummeted after a similar study two years ago showed stents were no better than drugs at preventing death and heart attacks in all types of heart patients, are likely to face more hardship over the research conclusion.

Stents are wire mesh tubes that prop open diseased arteries after they have been unclogged during angioplasty.

Dr. William Boden of the University at Buffalo in New York said in a commentary in the journal that doctors should question why so many diabetics still get angioplasty.

Boden wrote: "The continued high rate of use of (angioplasty) (1.24 million procedures per year in the U.S.) and the high rate of drug-eluting stent usage strongly suggests that we critically reassess our approach to revascularization, if needed, in diabetics with coronary disease."

Wachovia analyst Larry Biegelsen said diabetics with stable chest pain account for about 40 percent of all U.S. patients who get angioplasty, and he suggested that the findings could cut U.S. procedures by 3 percent.

But some experts have downplayed the study’s findings, like Laboratories Inc spokesman Jonathon Hamilton, who noted that many patients in the study were treated with older stents.

Abbott said that newer stents might have shown a benefit over medical treatment.

The researchers also studied the risks and benefits of two strategies for controlling blood sugar in patients with type 2 diabetes.

The first study group took insulin injections or drugs known as sulfonylureas that boost the body's production of insulin, while the second group took insulin-sensitizing drugs like metformin or drugs known as glitazones, which include Avandia or Takeda Pharmaceutical Co's pioglitazone, brand name Actos.

About 60 percent of patients in the insulin-sensitizing group took rosiglitazone or Avandia, Orchard said, adding that there was no increased risk of heart attacks among patients in this group.

More than 65 percent of people with diabetes die from heart disease or stroke.


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GlaxoSmithKline

University of Pittsburgh

NEJM

Source: redOrbit staff

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