Study in New England Journal of Medicine re Heart Surgery in Diabetics

Hi Everyone,

Just a reminder that although I don’t have diabetes myself, since many people I know do, I like to update you all of any news I hear that might be helpful to you. I read this today in an email I received from The Bottom Line. By the way, as Regent of my Daughters of the American Revolution Anne Hutchinson Chapter in NY, one of my group projects is trying to spread the word to get more attention for diabetes, with the hope that more funds will be given for research and to find a cure. Good luck to you all.

April Sandmeyer

Published in the Bottom Line newsletter:

"Ineffective Heart Surgery Performed on Diabetics

If you have diabetes and heart disease – and many
Americans do, or will, since the two tend to go hand in
hand – it is important to be aware of special
considerations regarding your treatment, especially when it
comes to invasive heart procedures.

A Landmark Study

Surprisingly, there is no clear consensus on how to treat
diabetic patients with heart disease. That, coupled with
concern about the exorbitant cost of treating diabetes (it
now accounts for one out of every five federal health-care
dollars spent), led researchers to undertake the Bypass
Angioplasty Revascularization Investigation (BARI 2D)
trial, which is a comparative effectiveness study of two
different treatments for diabetic patients with heart

In the five-year randomized, clinical trial of 2,368
diabetics with heart disease at 49 sites in six countries,
researchers compared optimal medical therapy (medications
and lifestyle counseling) with the same plus surgery to see
which worked best in preventing a cardiovascular event
and/or early death. These patients were generally
considered to be at low risk for heart attack and stroke
based on the extent of their coronary artery disease and
symptoms, such as their degree of angina (chest pain), when
the study began. The “optimal medical therapy” (e.g.,
medications such as beta-blockers and statins) was given to
all participants to control blood pressure and cholesterol,
and participants were also counseled, as appropriate, to
quit smoking and/or lose weight, notes William E. Boden,
MD, FACC, clinical chief of the division of cardiovascular
medicine and professor of medicine and preventive medicine
at the University at Buffalo Schools of Medicine & Public

For the group that received medical therapy plus surgery,
half the participants were randomly assigned to either
undergo stent angioplasty or coronary-artery bypass
grafting (CABG).Â

Over the five-year period following the intervention, Dr.
Boden and his colleagues found that…
*There was little or no difference in outcome between those
who underwent angioplasty versus only optimal medical
therapy – angioplasty patients had a 10.8% death rate,
compared with a 10.2% death rate among those on optimal
medical therapy.
*In the bypass group – which included individuals with
more severe heart disease – surgery was more effective
than optimal medical therapy. Bypass recipients had a 22.4%
chance of having a heart attack or stroke or dying in the
next five years, compared with 30.5% of participants who
only took medications.

These results were published in the June 2009 issue of The
New England Journal of Medicine.

High Tech Is Not Always the Answer

We’re often inclined to believe that high-tech devices and
interventions are superior, Dr. Boden observes. This is not
always the case – sometimes conservative medical therapy
is more effective, since it is less invasive and therefore
less dangerous, and it costs less, too. The BARI 2D
results confirm that intensive medical (non-surgical)
therapy can be an effective first line of treatment for
diabetics with heart disease, particularly for those with
less severe disease.

William E. Boden, MD, FACC, clinical chief, division of
cardiovascular medicine, professor of medicine and
preventive medicine, University at Buffalo Schools of
Medicine & Public Health, medical director, cardiovascular
services, Kaleida Health chief of cardiology, Buffalo
General and Millard Fillmore Hospitals, Buffalo, New York."

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