More than 500 individuals with diabetes were followed for more than 6 years. Van Belles team found that the amount of restenosis in the diabetics blood vessels six months after PTCA was associated with increased mortality most notably in a subgroup of diabetic patients with complete restenosis, known as the occlusive form, he says.
This is the first study to show that occlusive restenosis has a clinical relevance, and is one of the strongest predictors of mortality in the diabetic population, regardless of the usual risk factors like age, left ventricular ejection fraction, other diabetes-related complications, high blood pressure or coronary artery disease in multiple vessels, he says.
Van Belle adds that the study raises intriguing questions about how restenosis could be so critical in diabetics as compared to non-diabetics.
In an accompanying editorial, Burton E. Sobel, M.D., Amidon Professor and Chair of the Department of Medicine, University of Vermont College of Medicine, Burlington, suggests that the high levels of insulin in diabetics blood may affect clotting, protein breakdown or the types of cells involved in the re-closure process.
Non-diabetics have robust re-growth of smooth muscle cells, he explains. In contrast, diabetic restenosis contains more lipids the blood fats that figure in cholesterol levels and non-cellular material that is more likely to rupture and cause heart attacks or strokes.
In his own practice, Van Belle brings diabetic patients back for a follow up angiography to check for re-blockage six months after PTCA.
It is critical in the management of diabetic patients for physicians to understand the reasons for their
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Contact: Carole Bullock
caroleb@heart.org
214-706-1279
American Heart Association
4-Mar-2001