Study results show that patients with Type 2 diabetes who are treated with insulin or a thiazolidinedione (TZ) have fewer highly stenotic coronary artery lesions than those not treated with these drugs regardless of duration of diabetes, glycemic control, or other risk factors.

“Patients with diabetes continue to die of coronary artery disease (CAD) at rates two to four times higher than patients without diabetes, despite advances in treatment of cardiovascular disease,” say Teresa Jones (National Institutes of Health, Bethesda, Maryland, USA) and co-investigators.

They explain that “the role of glycemic control therapies, independent of their glucose-lowering effects, on cardiovascular disease is a recurring question.”

To investigate this further, the team assessed the association of different glycemic control therapies (insulin and TZs) with the extent of CAD found on angiography in 1803 participants of the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial.

All participants had Type 2 diabetes, documented CAD, no previous revascularizations, and were aged 62.1 years on average.

As reported in the American Journal of Cardiology, the researchers found that individuals who were using insulin at baseline had 23% less highly stenotic lesions and a significantly lower myocardial jeopardy index than those not using insulin. This was despite having a worse overall cardiac risk factor profile, increased inflammatory markers, and a higher prevalence of unstable angina than non-users.

Type 2 diabetics who had been taking a TZ for 6 months or more at baseline had 17% fewer highly stenotic lesions and significantly lower levels of the inflammatory markers C-reactive protein, fibrinogen, and plasminogen activator inhibitor-1 than those not taking TZs.

Of note, participants who were taking insulin and a TZ had 43% fewer highly stenotic lesions than patients taking neither treatment.

As this is significantly less than for individuals taking either treatment alone the researchers suggest that “different mechanisms or factors relating to CAD… might be affected by these two therapeutic classes.”

The authors caution that their results need to be confirmed by further research.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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