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“Although intensive glucose control had no benefit on the rate of
major cardiovascular events in previous studies, our data suggest
that strict glucose control after PCI (heart catheterization) can
improve long-term clinical outcomes in diabetic patients,” Dr. Joo-Yong
Hahn from Samsung Medical Center in Seoul told Reuters Health.
Heart disease is the major cause of death among people with type 2
diabetes, Hahn’s team writes in Circulation: Cardiovascular
Interventions. Although intensive blood sugar control is known to
reduce damage to tiny blood vessels that are involved in many of the
nerve and circulatory effects of diabetes, it’s not clear if the
same is true for major arteries such as the ones that carry blood to
the heart.
The researchers studied 980 patients with type 2 diabetes who had
undergone percutaneous cardiac intervention (PCI) to clear a blocked
coronary artery and place a supportive mesh tube known as a stent.
Hahn’s team followed the patients’ health for up to seven years.
They looked at long-term blood sugar control using a measurement
known as hemoglobin A1c (HbA1c or A1C), and used it to compare the
patients’ risks of death, heart attack, repeat catheterizations and
stroke over the study period.
The researchers defined good control as an A1C score below 7.0 and
poor control as A1C of 7.0 or higher. Then they matched patients
according to other risk factors and ended up with 322 pairs of
patients for comparison.
In the overall group of 980 patients, the risk of all bad outcomes
was 25 percent lower with good blood glucose control than with poor
blood glucose control.
In the matched comparison, some 37 percent of patients with poor
control had bad outcomes (heart attack, stroke, and so on) over the
next seven years, versus less than 28 percent of patients with good
control. Most of the difference in bad outcomes between the groups
resulted from a higher rate of repeat stenting in the group with
poor blood glucose control.
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“PCI is not the end of treatment for coronary artery disease,” Hahn
said by email. “Optimal medical treatment, including glycemic
control, is a cornerstone therapy after PCI,” he said.
“The effects of glucose control in type 2 diabetes may differ
according to patient characteristics, such as recent cardiovascular
events, baseline glycemic control status and duration of diabetes,”
Hahn added.
The researchers write that more study is needed before they can
conclude strict glucose control after stenting will improve
long-term clinical outcomes in people with diabetes.
It’s important to underscore the message of good glycemic control,
said Dr. Azfar G. Zaman from Newcastle University in the UK. He was
not involved in the study but has done similar research. “In
patients with PCI there is evidence to support better outcomes and
need for fewer interventions,” Zaman said by email.
“This is a single center study with limited numbers, but the
findings support data from other studies,” he noted.
SOURCE: http://bit.ly/2pjU0al Circulation: Cardiovascular
Interventions, online April 3, 2017.
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