Drugs Best First Defense Against Heart Disease for Diabetics

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Results from another ongoing trial "may shed more light" on the issue, the statement added.

What the study did show was that for people with diabetes and stable coronary artery disease, "a strategy of prompt revascularization [surgical opening of arteries] did not benefit patients relative to medical therapy alone," said trial leader Maria Mori Brooks, associate professor of epidemiology at the University of Pittsburgh Graduate School of Public Health.

Increasing severity of disease seemed to matter, however. "For patients who had more severe heart disease, there was a benefit from bypass surgery vs. medical therapy alone," she said.

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That benefit was not seen in survival rates, which did not differ much in groups given various treatments. The real gap in outcomes came in the rate at which patients suffered major cardiovascular events such as heart attack and stroke. Those were significantly lower when bypass surgery was added to drug therapy, the researchers found.

The results confirm those of a similar trial reported two years ago, noted Dr. William Boden, a professor of medicine and preventive medicine at the State University of New York, and co-author of an editorial accompanying the journal report. In particular, the new study showed that if a procedure is needed to restore coronary blood flow, "bypass surgery is more likely than angioplasty to reduce the incidence of recurrent heart attacks. No other study to my knowledge has shown that bypass surgery reduces the incidence of myocardial infarction [heart attack]," he said.

Yet dissent arose even on that point.

Dr. Kirk Garratt, director of interventional cardiovascular research at Lenox Hill Hospital in New York City, said that the new trial did not directly compare bypass surgery with angioplasty. Outcomes differed because physicians were free to choose between the two methods of restoring blood flow, and they were more likely to choose bypass surgery for more complex cases, he said.

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