Drugs and Lifestyle Versus Surgery for Heart Disease

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Medicine and lifestyle modifications produce similar survival rates to angioplasty surgery in people with mild to moderate coronary artery disease (a condition marked by the narrowing of small blood vessels that supply the heart) and Type 2 diabetes, according to recent data out of the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. Coronary artery disease is the leading cause of death in people with Type 2 diabetes.

The researchers, who sought to identify the best treatments for people with Type 2 diabetes and heart disease, looked at 2,368 people with Type 2 diabetes and heart disease over the course of roughly five years. Participants were randomly assigned to receive either prompt heart surgery along with intensive medical therapy or intensive medical therapy alone. In addition to the treatment recommended by each person’s physician, medical therapy consisted of medicines for cholesterol, diabetes, and blood pressure, and lifestyle modifications such as weight management and counseling to quit smoking.

At the end of the study period, the data showed that people who had mild to moderate coronary artery disease who were treated with medical therapy alone were no more likely to have died from a heart problem after five years than those who had received an angioplasty (a surgical procedure that clears an arterial blockage by inserting a balloon into the artery and then inflating it) in addition to medical therapy. In people with more extensive heart disease, however, coronary bypass surgery significantly decreased the risk of heart attack and heart-related death.

According to lead investigator Bernard R. Chaitman, MD, “Our research found that people with Type 2 diabetes and heart disease have a more favorable prognosis with proper medical care and management of risk factors, including cholesterol, blood pressure, high blood sugar levels, and smoking than previously thought… Our research found that angioplasty is not always necessary in preventing a heart attack or cardiac-related death just because a blocked artery is present. Patients with Type 2 diabetes and heart disease need to have a frank discussion with their doctors about their treatment options and what’s best for their individual case.”

To learn more, read the article “Hope for Patients With Type 2 Diabetes” or see the study in Circulation.

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