Drug Therapy, Not Angioplasty, May Be Better Option for Patients with Diabetes and Heart Disease

According to results from the National Institutes of Health Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes (BARI 2D) study, many patients with diabetes and heart disease may achieve better results with drug therapy instead of angioplasty.

A press release from the Stanford University School of Medicine said that, coupled with results from prior research (particularly the COURAGE trial) showing that “patients with type-2 diabetes and mild-to-moderate heart disease have no reduction in risk for heart attacks, strokes, or death” if they have an angioplasty compared with drug therapy, the new data showing that there is a “substantial cost savings” associated with drug therapy in this patient population may have patients and providers rethinking their approach to treatment. According to the press release, using drug therapy instead of angioplasty produced an average savings (based on the accumulated costs for hospitalizations, doctors’ visits, drugs, tests, and nursing home placements) of $11,000 per patient over four years.

The more than 2,000 patients who participated in the BARI 2D study received “intensive drug therapy according to accepted clinical guidelines, with use of statins, aspirin, beta-blockers and either ACE inhibitors or angiotensin-receptor blockers,” and were followed for more than five years.

Mark Hlatky, MD, professor of health research and policy and of cardiovascular medicine at Stanford University School of Medicine said that “For patients with relatively mild symptoms of heart disease, angioplasty is clearly more expensive and it’s clearly not more beneficial” than treatment with drug therapy. However, the systemic bias in favor of treatment via procedures over medication treatment, coupled with physicians’ and patients’ natural desire to “do something” about the blockage may mean there will be some resistance to embrace these findings.

“Once you see a blocked artery on an angiogram, there’s an overwhelming desire to fix it,” said Hlatky. “You want to see it look better, so you want to go open it up‑‑but what’s really important is the patient’s risk of dying and stroke. And modern medical therapy is really effective, and works just as well as angioplasty for a lot of patients… Patients with diabetes and heart disease need to be on effective drug treatments whether or not they have a procedure.”

The study results were presented at the recent Scientific Sessions of the American Heart Association and were published in the journal Circulation.