For Diabetics, Heart Drugs Are Just as Effective as Bypass Surgery or Stents

NEW ORLEANS, June 8, 2009— -- Cardiac bypass surgery, angioplasty and stents were no better than standard drugs for treating patients with stable heart disease -- even in the high-risk diabetes population, according to a long-awaited study.

Virtually the same proportion diabetic heart patients -- 88 percent -- were alive after five years whether doctors used a surgical or non-surgical approach to treatment, researchers reported at the American Diabetes Association.

Likewise, there was no statistical difference in how likely patients were to remain free of heart attack, stroke and other major heart problems.

Dr. Trevor Orchard of the University of Pittsburgh, lead author of the study, said the results mean that most diabetic heart patents can stay on non-surgical therapy unless their arteries become so blocked that there's no other option.

"There's no compelling reason for urgency," he said.

For cardiologists, the research project, known as Bypass Angioplasty Revascularization Investigation 2 Diabetes study (BARI 2D), provided more conclusive proof that there is relatively little advantage in bypass surgery or stenting in most cases, even with patients whose heart disease is complicated by diabetes.

It's the latest round in an old debate about whether to treat patients who have narrowed coronary arteries with medicine or to use surgical procedures.

The surgical procedures go by the general term "revascularization" because they deal with the blood vessels that supply the heart.

One kind, called Percutaneous Coronary Intervention (PCI), generally involves angioplasty and stenting.

A doctor threads a balloon-shaped tube from an artery in the groin to a blocked artery in the heart. The balloon is inflated, compressing the plaque blocking the artery and widening it to allow increased blood flow. The doctor may also insert a wire mesh tube called a stent, which props the artery open for a longer-lasting fix.

The advantage of PCI is that it doesn't require opening the body, although it is still a surgical procedure and considered riskier than treating heart disease with medicine alone.