Heart choice for diabetics.

In response to the results of a government-sponsored study, federal health officials now recommend coronary bypass surgery rather than angioplasty for diabetics who need life-saving procedures to unclog arteries supplying blood to the heart. In angioplasty, a doctor inflates a balloon in a clogged artery to clear blockage.

Researchers from the National Heart, Lung, and Blood Institute (NHLBI) in Bethesda, Md., issued the alert last Thursday after the early release of findings from a study comparing bypass surgery to angioplasty in patients with two or more blocked coronary arteries. The study found that among diabetics taking either insulin or oral hypoglycemics, 35 percent of those who underwent angioplasty died within 5 years, compared to 19 percent of those undergoing surgery. Nondiabetics faced a 9 percent death rate over 5 years for either procedure.

"We knew that diabetics as a group were at greater risk," says NHLBI cardiologist and study program director George Sopko. "But the difference in survival was surprising."

Sopko suggests that differences in healing between diabetics and nondiabetics may account for the disparity. Angioplasty causes tears in the artery, which can result in excessive scarring and reclogging. He adds that the patients in the study had serious heart disease and that angioplasty may be acceptable for diabetics with less severe disease.