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WASHINGTON - Drugs are just as good as prompt bypass surgery or angioplasty to open blocked heart arteries for diabetics with stable heart disease, according to US researchers.
The study, unveiled on Sunday, also found that quick bypass surgery in patients with more severe heart disease did not decrease their mortality but lowered their risk of later major cardiac events.
"In combining the two revascularisation approaches, we found that prompt revascularisation did not hold any advantage over intensive medical therapy alone with regard to total mortality," said Trevor Orchard of the University of Pittsburgh, which led the study published in Thursday's issue of the New England Journal of Medicine.
But Orchard also noted in a statement that "prompt coronary artery bypass surgery, compared to intensive medical therapy alone, had significantly better outcomes when cardiovascular events were considered in addition to death."
A major part of that benefit involved a reduction in non-fatal heart attacks, which the study noted had never been shown before with bypass surgery.
Nearly 24 million Americans suffer from diabetes, a disease linked to high blood glucose levels due to difficulties in the body's ability to produce or
use insulin.
The study, which was presented at an American Diabetes Association meeting in New Orleans, involved 2,368 patients with both type 2 diabetes and stable heart disease who were randomised to receive both drugs and prompt revascularisation treatment or only drugs.
Angioplasty opens blocked arteries by inserting metal stents or balloons through the arteries.
The results found no significant difference in survival, heart attack or stroke rates after five years, with an 88.3 per cent survival rate for the group receiving either bypass surgery or angioplasty, compared to 87.8 per cent for the drug therapy group.
No significant difference of survival was found either between patients who received insulin-providing drugs (87.9 per cent survival rate) and those who
received insulin-sensitising drugs (88.2 per cent).
However, patients with more severe heart disease who underwent bypass surgery "seemed to do particularly well on insulin-sensitizing drugs," said Robert Frye of the Mayo Clinic College of Medicine and chairman of the study.
But he cautioned that the result was "preliminary because we did not set out to answer this question with our study design."
The results of the study, which was funded in part by the drug maker GlaxoSmithKline and conducted at 49 clinical sites in the United States and abroad "reassure us that our current major drug treatments for diabetes are equally appropriate" as revascularisation, said Saul Genuth of Case Western Reserve University.
For patients with type 2 diabetes who have more sever heart disease "it may be better to do bypass surgery early than to wait and simply treat with medication," Genuth said.
But for patients with milder heart disease considering angioplasty, "it is appropriate to treat with drug therapy first," he added. - AFP/ra
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