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By Martha Kerr
ORLANDO, Fla., Mar 21 (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.
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