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People with diabetes are twice as likely as nondiabetics to suffer a heart attack - most diabetes patients die of heart disease - and for years, physicians have used aggressive drug treatments to lower that risk. To that end, the goal has commonly been to lower blood sugar or control blood-sugar spikes after eating, lower triglycerides and reduce blood pressure in diabetes patients to levels closer to those of healthy, nondiabetic individuals. By using medication to treat these factors, which are linked to a higher risk of heart attack and stroke in other patients, doctors assumed they would also be reducing...
...results of the remaining two arms of the trial - one in which patients were treated with blood-pressure-lowering drugs and another in which they received statins to reduce cholesterol and fibrate medications to slice their trigylceride levels - showed the same trend, finding that aggressive drug treatment did little to reduce the volunteers' risk of developing heart problems...
...remainder had risk factors, other than diabetes, that put them at high risk for heart disease, notes Dr. Om Ganda, director of the lipid clinic at Joslin Diabetes Center in Boston. That means the trial was not truly a primary-prevention study designed to test whether aggressive drug treatment could prevent a first heart attack in newly diagnosed diabetes patients...
Another reason these patients showed no significant heart benefits, he says, may be that most of them never needed the fibrate to begin with. About two-thirds of the patients in the trial already had triglyceride levels below those at which doctors would normally prescribe the drug, which skewed the study results toward the negative side...
Given that such aggressive drug treatment does not seem to afford significant benefits to diabetics on the whole, Saudek and his colleagues anticipate that going forward physicians and patients will increasingly reintroduce the importance of lifestyle changes, such as improving diet and getting more physically active, for slowing the progression of diabetes and reducing the risk of heart disease. These are therapies that are, after all, proven to work. "These discussions obviously should be going on the whole time, but these studies are one more reminder that medication therapy has its downsides," says Einhorn...