If you have diabetes and heart disease — and many Americans do, or will, since the two tend to go hand in hand — it is important to be aware of special considerations regarding your treatment, especially when it comes to invasive heart procedures.

Heart surgery causing conflicts with diabetics

A Landmark Study

Surprisingly, there is no clear consensus on how to treat diabetic patients with heart disease. That (coupled with concern about the exorbitant cost of treating diabetes which now accounts for one out of every five federal health-care dollars spent) led researchers to undertake the Bypass Angioplasty Revascularization Investigation (BARI 2D) trial, which is a comparative effectiveness study of two different treatments for diabetic patients with heart disease.

In the five-year randomized, clinical trial of 2,368 diabetics with heart disease at 49 sites in six countries, researchers compared optimal medical therapy (medications and lifestyle counseling) with the same plus surgery to see which worked best in preventing a cardiovascular event and/or early death. These patients were generally considered to be at low risk for heart attack and stroke based on the extent of their coronary artery disease and symptoms, such as their degree of angina (chest pain), when the study began. The “optimal medical therapy” (e.g., medications such as beta-blockers and statins) was given to all participants to control blood pressure and cholesterol, and participants were also counseled, as appropriate, to quit smoking and/or lose weight, notes William E. Boden, MD, FACC, clinical chief of the division of cardiovascular medicine and professor of medicine and preventive medicine at the University at Buffalo Schools of Medicine & Public Health.

For the group that received medical therapy plus surgery, half the participants were randomly assigned to either undergo stent angioplasty or coronary-artery bypass grafting (CABG).

Over the five-year period following the intervention, Dr. Boden and his colleagues found that…

• There was little or no difference in outcome between those who underwent angioplasty versus only optimal medical therapy — angioplasty patients had a 10.8% death rate, compared with a 10.2% death rate among those on optimal medical therapy.
• In the bypass group — which included individuals with more severe heart disease — surgery was more effective than optimal medical therapy. Bypass recipients had a 22.4% chance of having a heart attack or stroke or dying in the next five years, compared with 30.5% of participants who only took medications.

These results were published in the June 2009 issue of The New England Journal of Medicine.

High Tech is Not Always the Answer

We’re often inclined to believe that high-tech devices and interventions are superior, Dr. Boden observes. This is not always the case — sometimes conservative medical therapy is more effective, since it is less invasive and therefore less dangerous, and it costs less, too. The BARI 2D results confirm that intensive medical (non-surgical) therapy can be an effective first line of treatment for diabetics with heart disease, particularly for those with less severe disease.

Source(s):

William E. Boden, MD, FACC, clinical chief, division of cardiovascular medicine, professor of medicine and preventive medicine, University at Buffalo Schools of Medicine & Public Health, medical director, cardiovascular services, Kaleida Health chief of cardiology, Buffalo General and Millard Fillmore Hospitals, Buffalo, New York.

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Reprinted with the permission of:
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Your brain and heart are obviously very important parts of your body; so what happens if one is not working as well as the other?  Heart surgery has been shown to significantly impact the brain in a negative way. Let’s see why…

Avoid hurting your brain now

When arteries become blocked, coronary artery bypass graft (CABG) surgery often is the treatment of choice. Since its introduction in the 1950s, the number of patients undergoing the procedure has grown, and today it is one of the most common surgical procedures in the US, with about a half million procedures performed yearly.

CABG surgery can improve quality of life and, in many cases, it’s necessary for survival — but it is not without risk. A recent report in the online journal, MedLink Neurology, focused on one of the most common neurological complications of heart surgery — cognitive impairment, which includes disturbances in learning, memory, attention, concentration and speed of mental responses. “Recovering cognition may take six weeks or more,” says Harlan Krumholz, MD, professor of medicine and epidemiology and public health (cardiology) at Yale University School of Medicine. He emphasizes that many patients do ultimately recover completely.

Understanding the Risks

Even so, there is a high risk for cognitive decline during the five years after CABG surgery. While much of the variance depends on the patient’s condition before surgery, by and large, most such problems have been attributed to use of the bypass pump, which diverts blood from the heart and creates turbulence in the blood during the course of the surgery. This can result in emboli (blood clots or bubbles or plaque) and/or cause preexisting ones to dislodge. These may then flow up the carotid artery and into the blood vessels in the brain, potentially causing stroke. Some studies suggest this risk is reduced with off-pump CABG surgery, but according to Dr. Krumholz, the data is unclear on this issue.

Emboli can be especially dangerous at particular times. Most preexisting emboli are dislodged into the bloodstream immediately after releasing the aortic clamp at the end of surgery, when the force of blood coursing through the aorta can be likened to water flowing full-force through a garden hose. Emboli can also be formed as a result of arrhythmia (disruption in the normal heart rhythm), which can occur during or after surgery.

Another potential cause of cognitive problems, unrelated to emboli, is the chemical residue of anesthesia, of which the body must clear itself after surgery, Dr. Krumholz said. Having impaired circulation, which of course is common in heart patients, means that this isn’t likely to happen efficiently or easily; and the longer the anesthesia chemicals and their by-products remain in the blood, the more likely they are to cross the blood-brain barrier and impair cognition. According to Daily Health News contributing medical editor Andrew L. Rubman, ND, “when anesthesia is incompletely processed, it’s more likely to affect the central nervous system over the longer term.”

Who is at Risk?

Reiterating that many of the people who require heart surgery have vascular disease, Dr. Krumholz told me that it can be tough to tease out whether subsequent cognitive impairment is a result of the preexisting condition or the surgery. He said that even though age increases risk for post-op neurological problems, the reality is that CABG is often performed on patients who are quite old and quite sick. Vascular disease — including high blood pressure, diabetes, a blocked carotid artery, significant plaque in the aorta, kidney problems, a clot in the heart or prior strokes — boosts risk as well, exponentially. Other factors, including the length of time that a patient is on a bypass pump and whether or not a particular kind (an intra-aortic balloon pump, which is the most widely used mechanical circulatory support) is used contributes to risk for cognitive decline as well.

Natural Therapies Can Help

“There are several ways that you can help your body to be less affected by the challenges of the surgery,” says Dr. Rubman, noting that “the more prepared you are, the less likely you are to develop either short- or long-term cognitive deficiency.”

To prepare for CABG, Dr. Rubman suggests starting as soon as possible to take…

• Omega -3 fatty acids, found in the oils of fatty fish, such as salmon, or as a supplement, for their anti-inflammatory effects.
• Vitamin E supplements to prevent emboli formation.
• L-carnitine, an amino acid in capsule form, to help the heart and brain burn fat as a fuel. This allows the brain to function better should oxygen levels be reduced due to the surgical process or complications. Optimally, this should be started at least three days before surgery.
• Neprinol, a product that breaks down fibrin, thereby reducing the likelihood clots will develop. Start a few weeks before surgery.

Dr. Rubman emphasizes that dosages and timing for these supplements must be individualized and should be done with expert oversight. It is best if your treatment team includes a naturopathic physician who specializes in diet, nutrition and supplement therapy.

For people who have already had CABG: If you weren’t able to take these supplements before surgery, it’s not too late to improve your outcome, Dr. Rubman says. Start right away, and remember that it is absolutely vital that your cardiologist and surgeon be involved, as these interventions are not only not appropriate for all patients, but may be harmful to some.

The Good News

According to Dr. Krumholz, technological advances in CABG surgery have been “huge” and surgeons are also now able to utilize strategies to reduce the risk of stroke, including filters that prevent emboli from recirculating in the blood. “CABG surgery can be accomplished with excellent results, but the expertise of the surgical team is critical, and the institution you choose should have extensive experience with this type of surgery,” he said.

Source(s):

Harlan M. Krumholz, MD, professor of medicine and epidemiology and public health (cardiology), section of cardiovascular medicine, Yale University School of Medicine, New Haven, Connecticut.

Andrew L. Rubman, ND, medical director, Southbury Clinic for Traditional Medicines, Southbury, Connecticut. www.naturopath.org.

Take the time to look through all your meal options and get exactly what you want. Make sure that you include one of the Medifast Coupons so that you can get a great discounted price on your next Medifast Diet Plan.

Reprinted with the permission of:
Bottom Line Publications/Daily Health News
Boardroom Inc.
281 Tresser Blvd., 8th Floor
Stamford, CT 06901
www.BottomLineSecrets.com