Study Explains Why Diabetics Face High Risk From Angioplasty
Sobel is chair of the department of medicine at the University of Vermont School of Medicine in Burlington.
Experts say the new findings are likely to have an important effect on the way patients are treated because so many diabetics are candidates for angioplasty. While diabetics make up only 5% of the general population, they account for 15-25% of the candidates for angioplasty, according to the American Heart Association.
"The importance of this study is that it links the findings about restenosis to mortality," Sidney Smith, MD, chief science officer for the American Heart Association and professor of medicine at the University of North Carolina School of Medicine in Chapel Hill, tells WebMD. "This is a very interesting report that joins a growing body of evidence showing that diabetics who are treated with balloon angioplasty and who are not given the newer antiplatelet agents have a higher incidence of restenosis and do less well."
Smith is chair of a committee of the American Heart Association that is studying angioplasty in patients with diabetes.
He notes that in the U.S., 80% of all patients -- diabetic and nondiabetic -- already receive a stent to prevent restenosis. Like Van Belle, Smith says the use of anticlotting agents -- especially the drug abciximab-- can be extremely beneficial to diabetic patients receiving angioplasty.
But Smith drew attention to the fact that in Van Belle's study, even the diabetic patients who did not experience restenosis had a high death rate after angioplasty. For that reason, he stressed that better control of all of the known risk factors in diabetes -- including blood pressure, cholesterol, and smoking -- can improve the outlook for patients undergoing the procedure.
"The real question now is, if we use stents and antiplatelet agents and if we tightly control the medical risk factors, will we see a significant improvement for patients with diabetes undergoing [angioplasty]?" Smith asks. "My prediction is that we will. But we need the randomized control trials to show it."