Your heart can let you down

“Despite all the wonderful advances we have made in cardiology, people with diabetes don’t enjoy the same magnitude of benefit,” said study author Dr Elliott M. Antman, a senior investigator at Brigham and Women’s Hospital, in Boston.

The findings are published in the latest issue of the Journal of the American Medical Association.

The researchers have used data on more than 62,000 people enrolled in 11 related trials that evaluated therapies for acute coronary syndromes. The numbers were universally grim for the 17 per cent of people with diabetes.

The increased risk was very evident for people who had unstable angina and less severe heart attacks — a 2.1 per cent death rate over 30 days for diabetics, compared to 1.1 per cent for non-diabetics.

And the risk persists. The study found that one year after an acute coronary syndrome, the death rate for diabetics who had unstable angina and a mild heart attack was close to that of non-diabetics who suffered severe heart attacks — 7.2 per cent vs. 8.1 per cent.

“We need aggressive strategies to manage the diabetic population,” Antman said. “What we need to do is everything to halt the epidemic of diabetes and find through research what therapies are most helpful for diabetic patients. We’ve got to do better for those patients.”

The numbers in the new study come as no surprise to Dr Larry C Deeb, president of medicine and science for the American Diabetes Association and a clinical professor of pediatrics at the University of Florida.

“Everyone in his right mind has known that people with diabetes have been dying more regularly than people without diabetes,” Deeb said.

But the report does provide detailed data on the intersecting effects of other risk factors, such as age and body mass

index, he said. “You can tear the data apart and get intriguing things out of it,” he added.

Deeb agreed with Antman that more effort is needed on the link between cardiac disease and diabetes. “We’ve got to be doing better than what we’ve been doing,” he said. But when asked for a specific example of what needs to be done, he replied, “I’m not sure anybody knows.”

Cooperation between cardiologists and the endocrinologists who treat diabetes is not always easy, because these are two distinct specialties, said Deeb, who is an endocrinologist.

He noted that the journal report did not include information that could be of interest to endocrinologists: “What was the effect of diabetes control on having a heart attack? What the report doesn’t do is put diabetes control in there,” Deeb said.