Diabetics are at higher risk for coronary artery blockages than non-diabetics, and their blockages are often different and harder to treat.
Stents, the drug-coated mesh cylinders installed to open narrowed coronary arteries, for instance, are more difficult to install in diabetics and often don't hold up as long.
That may be changing thanks to a new drug-eluting stent that showed promising results in international clinical trials and was approved for use by the Food and Drug Administration in February.
Dr. David Dobmeyer, a cardiologist at St. Anthony's Medical Center, recently put four of them in Dennis Gifford, 63, of Lemay. He had put six other stents in Gifford, a diabetic, during the previous four years for a total of 10.
"Dr. Dobmeyer has done a great job of keeping me alive, and the stent is what has actually done it," said Gifford. "But I've been concerned about the aging stents. Every time I turn a corner, there's a new blockage somewhere. And being diabetic, you have a lot of other things you have to worry about besides whether a vessel is going to stay open."
Coronary artery disease, the most common type of heart disease, is the leading cause of death in the United States. It's caused by a buildup of fatty deposits, or plaque, in coronary arteries. People with diabetes run two to three times the risk for coronary artery disease than non-diabetics as well as a higher risk of dying from it.
Patients with coronary blockages, who are not diabetic, have focused areas of narrowing, sort of like a "napkin ring constriction" of the artery, which are usually simpler to treat, Dobmeyer said. But diabetics have blockages that are much more diffusely constricted.
"Rather than one little blockage, they'll have an entire artery full of plaque," he said.
The new stent, which is made by Medtronic, prevents the artery from narrowing again by eluting a drug into the arterial wall that is designed to block growth of lesions and blood clots.
FDA approval of it has been years in the making. More than 5,100 patients were enrolled in a large randomized clinical study at 250 sites in 32 countries. About a third of them had diabetes, which mirrors the rate in the U.S., according to the medical journal, Cardiology Today. The stents consistently performed well on a wide range of patients, including those who had diabetes.
Doctors at Barnes-Jewish Hospital participated in the trials and have inserted more than 200 of the drug-eluting stents.
Dobmeyer said the new stents don't cost patients more than traditional ones.
Gifford hopes all his stents last and don't have to be replaced. But he's glad to have the drug-eluting ones.
"You have to think through the years because this is an ongoing thing through my life," he said. "There are some things that get you excited about, and one of them is knowing you may never have to deal with that particular artery again."
Editor's note: A correction has been made in paragraph nine to include the correct name of the manufacturer of the stent.