Patient Care Endocrinology & Cardiology - December 2007 - (Page 5)

MEDICINE in the News CABG or PCI? It’s a dead heat Both procedures relieve angina for most patients, but more patients report relief 5 years after undergoing CABG (84%) than after PCI (79%). Repeat revascularization CABG has a clear advantage. Five years after the initial procedure, only 9.8% of CABG patients needed revascularization compared to 46.1% of those treated with balloon angioplasty and 40.1% of patients who had stents. The authors caution that only 1 small trial using drug-eluting stents was included in the study, and few patients with extensive coronary disease or poor ventricular function were enrolled. Further studies will be needed to explore the impact of those omissions. Angina relief 1. Bravata DM, Gienger AL, McDonald KM, et al. Systematic review: the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass surgery. Ann Intern Med. 2007; 147(10):1-15. f a patient asks your advice about which procedure you recommend for angina—a coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI)—what do you say? Until now, the comparative effectiveness of the 2 procedures has been poorly understood. An extensive review of the literature has just become available to raise the level of clinical understanding.1 The researchers analyzed 23 randomized controlled trials in which 5019 patients were assigned to treatment with PCI and 4944 to the CABG procedure. Here is what the researchers found: Survival After 10 years of follow-up, the difference in survival between the 2 procedures was less than 1%. This equivalence in survival was as true for patients with diabetes as for all patients in the database. Procedural strokes These were more common after CABG (1.2% of patients) than after PCI (0.6%). I Diabetes regimens: For some, the treatment is worse than the disease Clinicians know that achieving diabetic control helps protect patients against dire complications. So clinicians prescribe a regimen that usually involves restrictive diets, exercise programs, frequent glucose testing, and oral and injected medications. What is not known is how patients weigh the burden these treatments exact against a range of possible complications in terms of quality of life. That is what the researchers tried to find out, in interviews with a multiethnic sample of 701 adults with diabetes attending Chicago area clinics.1 After describing the complications, the researchers asked participants “Would you rather have 10 years of life ahead of you on this treatment or fewer years in good health without treatment?” When comparing mean utilities for complications and treatments, the researchers found that patients rated life with treatments as better than life with complications. But patients also perceived “comprehensive diabetes care” as having significant negative effects on quality of life, and these negatives were equivalent to life with several of the intermediate complications such as angina or neuropathy. The most burdensome treatment appeared to be multiple daily insulin injections. The authors conclude that modifying treatment regimens could improve quality of life for diabetes patients and increase adherence to life-saving interventions. 1. Huang ES, Brown SE, Ewigman BG, et al. Patient perceptions of quality of life with diabetes-related complications and treatments. Diabetes Care. 2007;30(10):2478-2483. News from the FDA Azor (amlodipine/olmesartan) was approved for treating hypertension. The drug, taken qd, is a single-tablet formulation of amlodipine, 10 mg /olmesartan, 40 mg. Januvia (sitagliptin) has received an expanded indication to include use as an initial therapy in combination with metformin as an adjunct to diet and exercise; as addon therapy to glimepiride when the single agent alone does not adequately improve glycemic control; and as add-on therapy to glimepiride plus metformin when the combination does not adequately improve glycemic control. Plavix (clopidogrel), 300-mg tablet, has been approved for appropriate acute coronary syndrome patients as soon as possible after hospital admission. WRITTEN BY JUDITH ASCH-GOODKIN AND DEBORAH KAPLAN DECEMBER 2007 PATIENT CARE ENDOCRINOLOGY & CARDIOLOGY 5

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Patient Care Endocrinology & Cardiology - December 2007 Research Digest Contents Medicine in the News Options for Managing Diabetes: Three Types of Basal Insulin Therapy Using the New AHA Guidelines for Preventing Coronary Heart Disease in Women Cardiovascular and Metabolic Implications of Polycystic Ovary Syndrome Case & Comment Classified Advertising Clinical Clips

Patient Care Endocrinology & Cardiology - December 2007

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