糖尿病患者に対する薬物療法と迅速な血行再建術の併用は有益である（Abstract # 12697）

心疾患を有する糖尿病患者において血行再建術を含む治療は血流改善に繋がる
Treatment that includes revascularization results in better blood flow in patients with diabetes and heart disease
心疾患を有する糖尿病患者において早期の血行再建術は強力な薬物療法単独と比較し心臓への血流をより改善するとのスタディ結果が2010年AHA学会で発表された。以前、BARI 2D（2型糖尿病におけるバイパス/血管形成術による血行再建術に関する調査[Bypass Angioplasty Revascularization Investigation 2 Diabetes]）において、薬物療法に加え血行再建術を施行された患者は血糖、血圧およびコレステロールコントロール（病状が悪化した場合にのみ後に手術を施行）の強化治療のみを受けた患者と比較し、死亡および心筋梗塞（MI）が少なくはなかったことが示された。今回のサブスタディでは、1,505人の対象者にストレス心筋潅流SPECTを施行し血流が十分な心筋領域を同定し計測した。試験開始後1年間に、薬物誘発性虚血が認められず異常なしとの結果であったのが血行再建術群患者の59%であり薬物療法群患者の49%であった。血流減少は血行再建術群患者の心筋組織の3%、薬物療法群患者の心筋の9%に認められた。虚血が多いほど死亡およびMIのリスクが高かった。この結果から、薬物療法および生活習慣介入で管理されている心疾患を有する糖尿病患者のスクリーニングの重要性が示唆された。
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Treatment that included early surgical procedures to open blocked arteries resulted in better blood flow to the heart than aggressive medical treatment alone in patients with both diabetes and heart disease, according to a study presented at the American Heart Association's Scientific Sessions 2010.

Previously, researchers in BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) found that over five years there were no fewer deaths and myocardial infarctions (MI) in people who had medical treatment along with prompt revascularization than in those who received only intensive treatment to manage blood sugar, blood pressure and cholesterol levels (with surgery performed later only if their condition worsened).

"Even though the main trial showed no difference in clinical outcomes, this study revealed that revascularization had a greater benefit in reducing the extent of ischemia which is often important in controlling symptoms," said Leslee J. Shaw, Ph.D., lead author of the study and professor of medicine at Emory University School of Medicine in Atlanta, Ga.

In the current sub-study of BARI 2D, 1,505 participants underwent stress myocardial perfusion SPECT to locate and measure areas of myocardium receiving sufficient blood flow. One year into the trial, researchers found:

  • Fifty-nine percent of revascularization patients and 49 percent of medical patients had normal results with no drug-induced ischemia.
  • Reductions in blood flow involved 3 percent of the heart tissue in revascularization patients and 9 percent of heart muscle in medical patients.
  • More ischemia was associated with a greater risk of death or MI.

The results indicate the value of scanning patients with diabetes and heart disease who are being managed with medication and lifestyle interventions.

"The benefits of lifestyle and medication take several months, so scanning after a year can provide a barometer of how effective your treatment has been at reducing ischemia," Shaw said. "Because nerves can be damaged by high blood sugar levels, people with diabetes don't always get chest pain when blood flow is reduced. This test can show reductions in blood flow whether or not you have symptoms, and a normal test can be very reassuring."

The BARI 2D trial compared various treatment strategies for patients with both type 2 diabetes and heart disease.

Co-authors are: Manuel Cerqueira, M.D.; Maria M. Brooks, Ph.D.; Veronica V. Sansing, M.S.; George A. Beller, M.D.; Rodica Pop-Busui, M.D.; Raymond Taillefer, M.D.; Bernard R. Chaitman, M.D.; Raymond J. Gibbons, M.D.; and Ami E. Iskandrian, M.D. Author disclosures are on the abstract.

The National Heart, Lung, and Blood Institute funded the study.