People who have Type 2 diabetes experience strokes or heart disease at more than twice the rate of others. But when  they and their doctors consider how to relieve dangerously narrowed arteries, they often wonder how best to prevent a heart attack or stroke. Should they use a prompt surgical intervention such as angioplasty or bypass, or drug therapy to control blood sugar, cholesterol, and blood pressure? A new University of Pittsburgh study published in The New England Journal of Medicine provides clues to the quandary.

Diabetes interferes with the body's ability to use the hormone insulin to convert blood sugar into energy. The researchers studied more than 2,300 Type 2 diabetes patients who also had stable heart disease. The patients were randomly assigned to be treated with either strategy— surgery (immediate angioplasty or a bypass, or drug therapy to provide more insulin or increase the body's sensitivity to it. The two strategies proved equally effective. Over five years, the patients who took pills were no more likely to have a heart attack, to have a stroke, or to die, than the patients who were treated with surgery.

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