In a study sponsored by the National Institutes of Health and published in the New England Journal of Medicine (360[24]: 2503-2515), researchers sought to determine the most effective therapy for patients with both type 2 diabetes and stable coronary artery disease. They compared two strategies for treating cardiac disease (medical therapy versus medical therapy plus revascularization) and two strategies for treating diabetes (insulin-sensitizing drugs versus insulin-stimulating drugs).
   Overall, researchers found that optimal medical therapy was as effective as elective revascularization (via angioplasty or bypass surgery) at lowering the risk of death, myocardial infarction (MI), and stroke. One caveat was that patients who had prompt bypass surgery plus optimal medical therapy had significantly fewer nonfatal MIs and strokes than patients who initially received only medical therapy. No such benefit was seen in patients who received angioplasty and stent placement. Patients who underwent bypass surgery typically had more severe cardiac disease than those in the angioplasty group.
   Researchers also found similar outcomes between insulin-sensitizing drugs and drugs that provide or stimulate insulin.
   The international trial took place at 49 clinical sites and included almost 2,400 patients. Patients had an average age of 62, type 2 diabetes of 10 years' duration, and stable coronary artery disease. After 5 years of follow-up, researchers found no difference in the percentage of patients who died (about 12% in both groups) or who had any cardiovascular event, fatal or not (about 23% in both groups).
   Such research is significant because 65% of people with diabetes die from cardiovascular disease.

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