Doctors at the annual meeting of the American College of Cardiology in Atlanta on Sunday got some surprising news on their first day of sessions. Researchers presented three studies revealing that some of the most widely prescribed medications to reduce the risk of heart disease in Type 2 diabetes patients appeared not to provide much benefit at all.


People with diabetes are twice as likely as nondiabetics to suffer a heart attack — most diabetes patients die of heart disease — and for years, physicians have used aggressive drug treatments to lower that risk. To that end, the goal has commonly been to lower blood sugar or control blood-sugar spikes after eating, lower triglycerides and reduce blood pressure in diabetes patients to levels closer to those of healthy, nondiabetic individuals. By using medication to treat these factors, which are linked to a higher risk of heart attack and stroke in other patients, doctors assumed they would also be reducing the risk in people with diabetes.


Read more: http://www.time.com/time/health/article/0,8599,1972325,00.html?hpt=T2

Tags: drugs, heart, risk, study, type2

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Actually, there has been substantial evidence that diabetics are at risk of heat attacks independent of cholesterol and blood pressure, something that has irked many in the medical establishment. Hence it is not surprising this latest finding that these drugs may not be effective. In particular, as David Nathan points out in the associated NEJM article (http://content.nejm.org/cgi/content/full/NEJMe1002322?resourcetype=...), valspartan turned out to not help heart attack rates although it does seem to work lowering blood pressure. The article further notes that efforts reducing postprandial blood sugars with nateglinide turned out to not only not work so well, but the heart attack rates in the treatment arm were higher than in the placebo, bummer. Nobody seems to want to study how increased blood sugar levels increase heart attack risk although the statistics seem pretty darn clear.

So at least in my narrow disturbed part of the world, I'll try to learn from this study, and encourage my doctors to balance the risks of aggressive medical treatment of cholesterol, blood pressure and blood sugar. Fortunately, there appears to strong evidence that lowering blood sugar blood sugar through diet, exercise and insulin use works well at reducing heart attack risk and is relatively side effect free.
Take a look at this post which talks about critically evaluating studies like this.

Even the Time article stated, "the trial was not truly a primary-prevention study designed to test whether aggressive drug treatment could prevent a first heart attack in newly diagnosed diabetes patients." and "all of the volunteers either already suffered from heart disease, or had two or more major risk factors for heart problems — including cigarette smoking, family history and high cholesterol — in addition to diabetes. That may have pushed their diabetes too far along to allow them to see any benefit from the drugs."
I would note that these comments refer to the ACCORD study, I've not looked closely enough to see what the study population was for the NAVIGATOR which looked at valspartan and nateglinide. Those are good points in Jenny's blog. Perhaps they should be called Jenny Ruhl's Rules.

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