Stents No Better Than Meds in Treating Heart Disease in Diabetics

We have long written about the controversy surrounding <"">cardiac stents

. Now, Reuters reports diabetics diagnosed with stable heart disease may not need invasive stent implantation, angioplasty, or bypass surgery.

Stents are tiny wire-mesh tubes used to prop open arteries after doctors clear them of blockages. Some stents have a drug coating meant to keep vessels from re-clogging.

According to Reuters, a newly-published study has found that patients tend to do as well on drug therapy alone as they do undergoing more invasive and dangerous angioplasty or bypass surgery. The researchers who conducted the study concluded such patients could try medications first to “restore blood flow and calm chest pain.” They also noted that patients with more severe disease are likelier to need the invasive approach to avoid a subsequent heart attack, noted Reuters. The University of Pittsburgh study appears in the New England Journal of Medicine

In a related commentary, Dr. William Boden of the University at Buffalo in New York said doctors should ask why so many diabetics are undergoing angioplasty. “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,” Boden wrote, according to Reuters.

But, said Dr. Trevor Orchard of the University of Pittsburgh, “If you have diabetes and heart disease such that a bypass surgery is a recommended procedure, you should have that early rather than delaying it,” quoted Reuters.

The University of Pittsburgh study involved 2,368 patients who received immediate angioplasty, generally with a stent and medication and those only on medication, said Reuters, adding that there were no differences in fatality, heart attack, or stroke rates over five years.

Reuters pointed out that the recent research might add to stent maker woes, including falling sales after prior studies revealed stents offered no better option over medication in stemming death and heart attacks in heart patients. Stent makers include Boston Scientific, Abbott Laboratories, Johnson & Johnson, and Medtronic Inc.

Wachovia analyst Larry Biegelsen pointed out that “diabetics with stable chest pain” account for nearly half—40 percent—of angioplasty surgeries in the United States, noting that medication therapy could reduce American procedures by three percent.

In a previous Reuters article citing an earlier study—the Occluded Artery Trial (OAT)— findings indicated that one year following stent implantation patients were as unable to climb stairs as those not implanted, and while 477 stent patients received hospital bills about $7,000 higher than nonstent patients, their quality of life was shorter after two years over those patients treated with medications only. That study was published earlier this year in the New England Journal of Medicine.

Of the more than 800,000 angioplasties conducted last year for a total of $10 billion, Duke University concluded that about half could have received comparable treatment via drugs, diet, and exercise, with less risk of re-clogging, reported Bloomberg News earlier this year, citing the prior studies.

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