"We found that treatment with bypass surgery or with angioplasty produced the same results in all patients, except those with diabetes--they had a higher death rate with angioplasty than with bypass surgery," says Dr. Katherine Detre at the University of Pittsburgh, one of the researchers who analyzed data in both studies.

People with diabetes face two- to four-times the risk for heart disease than those without diabetes. Heart disease occurs when coronary arteries (pipelines to and from the heart) become clogged, reducing blood flow. Doctors may use either angioplasty or bypass surgery to get blood flowing freely through the arteries again. In angioplasty, a tiny balloon on the end of a long tube (catheter) is inflated inside a clogged artery to enlarge the opening and thus improve blood flow. In a bypass operation, the doctor takes a blood vessel from the patient's leg or chest and grafts it below the blocked segment, bypassing the blockage.

In the most recent report from an NHLBI-funded registry of angioplasty patients, people with diabetes were found to have more severe and widespread form of heart disease. During the 9-year period after angioplasty, the researchers found that those with diabetes died at twice the rate of non-diabetic patients. They also found that rates for non-fatal heart attacks, bypass surgery and the need to repeat procedures to open arteries that clogged up again were higher for diabetic patients.

The earlier report was from a randomized study of patients who had blockages in two or more coronary arteries and were first-time candidates for either angioplasty or bypass surgery. The researchers found that the patients who required drugs or insulin to control their diabetes, had a significantly higher death rate after five years when they had angioplasty. Death rates were about the same for angioplasty and bypass surgery in all other patients.

The researchers say the high risk that people with diabetes face from angioplasty relative to bypass surgery has not been appreciated,and therefore doctors should carefully consider all the various treatment options that are available. They note that many technological advances made in medical care may now be improving today's efforts to unclog blocked arteries. NHLBI advises those patients with diabetes who have already had angioplasty and experience symptoms of heart disease--such as angina--to undergo evaluation by their physician to determine treatment options. Those with no symptoms of heart disease should continue to see their physician on a regular basis, and pay special attention to risk factors they can control such as diet, cholesterol levels, exercise, blood pressure and quitting smoking.--an NIH HEALTHWise report, November/December 1996

For more information on this study, reporters can contact:

Laura Vazquez Information Development Specialist, NIH 301-496-4461 fax: 301-496-0017 E-mail: lv16f@nih.gov

Carla Garnett Writer and Editor, NIH 301-496-2125 fax: 301-402-1485 E-mail: cg9s@nih.gov

How Can People with Diabetes Delay or Avoid Heart Disease

Watch your diabetes. Follow your doctor's advice every day about trying to keep your blood sugar in the range that is best for you.

Control your weight and blood cholesterol. Eating right--a low-fat, low-cholesterol diet--and getting regular exercise can help maintain your body's ideal weight and raise your "good" cholesterol level.

Watch your blood pressure. High blood pressure can be controlled through diet (limiting salt is especially important), exercise, or medication, if necessary.

Avoid smoking. Smoking is one of the major risk factors for heart disease that you can control.

For more information about diabetes, as well as diabetes research, statistics, and education, contact:

National Diabetes Information Clearinghouse HEALTHWise 1 Information Way Bethesda, MD 20892-3560 301-654-3327 E-mail: ndic@aerie.com

National Diabetes Outreach Program One Diabetes Way Bethesda, Maryland 20892-3600 1-800-GET LEVEL (438-5383)