Drug regime reverses heart disease in diabetics

By Andrew Stern

CHICAGO (Reuters) - Aggressive use of drugs to lower cholesterol and blood pressure helped reverse heart disease in people with diabetes, U.S. researchers said on Tuesday.

The three-year study of 499 Native American adults with type-2 diabetes showed that lowering blood pressure and cholesterol more than is usually recommended helped reverse thickening of the arteries and damage to the heart.

This is good news for everyone with diabetes, the researchers said -- especially Native Americans, who have high rates of the disease.

"These patients are two to four times more likely than people without diabetes to die from heart disease," said Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute.

"For the first time, we have evidence that aggressively lowering LDL cholesterol and blood pressure can actually reverse damage to the arteries in middle-aged adults with diabetes."

But other experts said the study, published in the Journal of the American Medical Association, did not resolve the debate over how low to go.

Advocates of aggressive treatment with cholesterol-lowering statins and blood pressure drugs argue the lower, the better, though conclusive data to support that view is lacking, wrote Duke University's Eric Peterson in a commentary.

"We know now that it's important to control risk factors for heart disease in people with diabetes, yet we don't know how far to aim," said Barbara Howard, who conducted the U.S. government-funded study with colleagues at MedStar Research in Hyattsville, Maryland.

The group receiving standard care had targets of low density lipoprotein -- "bad" LDL cholesterol -- of 100 milligrams per deciliter or lower, and systolic blood pressure (the higher number when the heart contracts) of 130 or lower. Those treated more aggressively had targets of 70 milligrams of cholesterol and blood pressure level of 115 or lower.

Blood pressure and statin drugs were provided to patients by Merck and Co and Pfizer Inc..

Ultrasound measurements taken of the carotid artery in the patients' necks -- a reliable indicator of hardening or thickening of the arteries that is a precursor to heart disease -- showed improvement in those treated aggressively with statins.

"We found that in the aggressive group there was actually a reduction in the thickness of the vessel in the neck as compared to the standard group whose neck vessels got a little bit worse ... That has not been seen in most studies," Howard said.

Measures of the heart's main pumping chamber found enlargement at the beginning of the study -- a sign of potential heart trouble -- was reduced by the blood pressure drugs, and shrinkage was greater in the aggressive group.

Howard predicted the observed changes would lead to fewer heart attacks and strokes among aggressively treated patients.

The study did not last long enough to find such a difference, though patients will continue to be tracked and additional research may draw a firmer conclusion.