Diabetes and Blocked Arteries: New Research

Diabetes and Blocked Arteries: New Research: USNews.com reports that there is now substantial evidence to indicate a specific treatment preference in diabetics with heart conditions. Let’s take a look at the two prevailing types of procedures when arteries clog.

Angioplasty
The National Heart, Lung, and Blood Institute define this process as, “A medical procedure in which a balloon is used to open a blockage in a coronary (heart) artery narrowed by atherosclerosis. This procedure improves blood flow to the heart.”

Heart Bypass
MedlinePlus defines this procedure as one that, “Creates a new route, called a bypass, for blood and oxygen to reach your heart. It is done to fix problems caused by coronary artery disease (CAD), in which the arteries that lead to your heart are partly or totally blocked.”

Which is better for diabetics?
A recent report authored by Dr. Mark Hlatky of Stanford University suggests that after the age of 65 a heart bypass is a highly preferred method of treating blocked arteries among diabetics. The USNews.com article indicates, “People with diabetes were 30 percent less likely to die if they had bypass surgery rather than PCI (Percutaneous coronary intervention). People 65 and older who had bypass surgery had a mortality rate of 20 percent, compared with 24 percent for PCI.”



One potential reason these statistics may be true is that in diabetics the blood vessels can become brittle and an angioplasty may actually serve to harm the vessels to a greater degree than a traditional bypass. Another potential possibility is that many individuals over the age of 65 have more extensive blockage and bypass surgery is generally viewed as most effective in treating this scenario.

This research data is important to a new paradigm in thinking when it comes to managed care. This approach is known as comparative effectiveness research. The goal of this type of study is to find the most effective treatment. This has the potential to decrease the long-term health care costs by looking at the bigger picture and not always the short-term solution. In fact the recent government stimulus package contained over a billion dollars dedicated to research using comparative effectiveness. The goal is to help reduce health care spending by managing long-term needs.

Interestingly there is only a .5% difference between mortality rates in patients that undergo a heart bypass and those who opt for an angioplasty.

It should be noted that this study was built on two factors – age and diabetes. For patients who do not have diabetes the findings may not be applicable.

MedPageToday.com reported that Dr. David P. Taggart, M.D., Ph.D., of Oxford University offered his own bullet points related to the findings.

  • For patients with less severe one-vessel or two-vessel disease and normal left ventricular function, “there is little prognostic benefit from any intervention over optimum medical therapy,” and those without diabetes who do need intervention get no obvious survival advantage with either PCI or CABG.
  • For patients with more severe coronary artery disease and especially those with diabetes, CABG is superior in terms of survival and freedom from reintervention.
  • For interventions in more complex coronary artery disease, a multidisciplinary team approach should be standard of care “to ensure transparency, real patient’s choice, and genuine informed consent in the decision-making process.”
  • For elective patients, angiography needs to be separated from intervention “to allow appropriate time to make a truly informed decision.”

This news should allow you to engage in meaningful dialogue with your health care provider should you be diagnosed with artery blockage.