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Diabetics
At Higher
Risk From Heart Disease
ORLANDO,
Fla. (Reuters Health) - Patients with heart disease and diabetes
have more than double the risk of dying during a certain time
period than similar patients without diabetes, according to an
analysis of two large clinical trials. The findings were presented
at the American College of Cardiology meeting here.
The trials
were originally designed to look at the effectiveness of a ``super-aspirin''
to prevent heart attacks and were halted when the drug showed
a lack of efficacy. But Dr. Darren K. McGuire of Duke Clinical
Research Institute in Durham, NC, says that an analysis of the
approximately 3,100 diabetics in the trials showed that their
mortality rate was markedly higher than non-diabetics.
The rate of
major cardiac events, such as heart attack, was 11% in diabetics
compared with 9% in non-diabetics. After one year of follow-up
in the trials, 6% of diabetics had died compared with less than
4% of nondiabetics.
``Diabetes
increased risk for every adverse cardiovascular event,'' McGuire
said.
Further, the
type of treatment the patient was on seemed to affect their risk
of dying. There was a 2.6-fold increased risk of death with insulin-providing
therapy, such as injected insulin and sulfonylurea drugs, compared
with insulin-sensitizing therapies, such as metformin.
Patients with
type 2 or adult onset diabetes lose their sensitivity to insulin,
the blood sugar-regulating hormone, and end up with elevated levels
of blood sugar. While diet and exercise can control some cases
of diabetes, some patients are treated with injected insulin or
sulfonylureas, which increase insulin secretion and thus lower
blood sugar. Patients can also be treated with drugs such as metformin,
which increase the body's sensitivity to insulin.
Ninety days
into the trials, 12% of diabetics on insulin-providing therapy
had a major adverse event compared with 5% of diabetics on insulin-sensitizing
therapy.
``Metformin
halved the risk of death in diabetics,'' McGuire told Reuters
Health. ``There seems to be a disconnect between lowering glucose
(blood sugar) and reducing cardiovascular risk.''
It may be
time to change therapies (for diabetes), based on the best available
evidence, which is still largely lacking,'' he said.
While treatment
is largely aimed at controlling blood sugar, this may not be the
best way to prevent heart attack, stroke or death, according to
McGuire. Elevated blood sugar levels may be a marker rather than
a causative factor in cardiovascular disease, the Duke researcher
said. Elevated insulin levels and a loss of sensitivity to the
blood sugar-regulating hormone may be the underlying risk factor
for mortality in these patients.
Reference
Source 89
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