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Author: Anita Manning
Source: USA Today, Wednesday, August 15, 2007

Analysis Confirms Years Of Research

A large analysis of clinical studies confirms what doctors have long known: People who have diabetes are at much greater risk of dying after a heart attack than those who don’t have the disease, researchers at Brigham and Women’s Hospital in Boston say.

The report in today’s Journal of the American Medical Association shows that diabetes increases death risk across the board, whether the heart attack is mild or severe. After a year, diabetics who have mild heart attacks face the same risk of death as non-diabetics who have severe heart attacks, says senior author Elliott Antman.

And, he says, the research shows that advances in cardiac care are not enough to offset the damage of diabetes.

“Diabetics are not reaping the benefits others have enjoyed of new therapies. We need new research on how we can treat diabetics.”

Antman and colleagues analyzed data from 11 clinical trails from 1997 to 2006. The studies involved 62,036 patients who had experienced acute coronary syndromes, or ACS, a designation representing conditions from unstable angina (partial blockage of an artery) through mild or severe heart attack. Among those were 10,613 diabetics.

The findings are especially strong because of the large number of patients involved in the studies and the fact that the studies were done using the most recent diabetes guidelines, set in 1997, Antman says. The research not only looked at short-term effects 30 days after a heart attack but also at what happened to patients a year later.

Diabetes is caused by the body’s failure to produce enough insulin or to use it effectively to reduce blood sugar levels. Over time, high sugar levels damage both large and small blood vessels.

That damage is reflected in the researchers’ analysis of heart testing data, which shows that patients with diabetes were more likely to have coronary artery disease involving multiple blood vessels. They have more extensive coronary artery disease, and they often have kidney dysfunction,” which could mean their ability to tolerate heart medications may be impaired, Antman says. “These are speculations” that could be answered with futher study.

The study found that diabetics were more likely than non-diabetics to be taking steps to reduce heart risks, says American Diabetes Association’s Larry Deeb. For instance, 37% of diabetics were on daily aspirin, and 18% were taking cholesterol-lowering drugs, compared with 25% and 11% respectively, for non-diabetics. That shows “we’re getting some messages out there,” he says, but not to enough people.

The report should encourage people with diabetes and their doctors to “be aware how big the risk is” of heart disease, Deeb says. “Preventing a heart attack is primary. You could argue it is as important as controlling blood sugar.”