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New research suggests that the electrocardiogram may not be an accurate guide if the patient is taking drugs called sulfonylureas for diabetes.
When a person seems to be having a heart attack, doctors take an electrocardiogram for clues to the severity of the attack and to decide if clot-buster treatment is need. Now,
Sulfonylurea drugs, such as glyburide or glipizide, lessen the magnitude of the increase in heart’s electrical activity — the so-called ST-segment elevation — that occurs during a heart attack, the study shows. Consequently, diabetics being treated with these agents may not be given potentially life-saving clot-busters.
The study, in the Journal of the American College of Cardiology, involved 88 diabetic patients who suffered a heart attack over a 4-year period in Framingham, Massachusetts. Forty of them were taking sulfonylureas and 48 were taking other types of drugs to lower blood sugar levels.
More than half (53 percent) of patients in the sulfonylurea group did not have the level of ST-segment changes on the electrocardiogram that would make them candidates for clot-busting therapy, compared with only 29 percent of patients taking other antidiabetes drugs (the control group).
Moreover, Dr. Jose F. Huizar, from Upstate Medical University Hospital in Syracuse, New York, and colleagues found evidence that the two groups were treated differently. While clot-busting agents were given to 40 percent of patients in the control group, only 20 percent of sulfonylurea-treated patients received such treatment.
Huizar and colleagues believe this is the first study to suggest that lessening of ST-segment elevation on an electrocardiogram during a heart attack occurs in diabetic patients treated with sulfonylurea drugs.
If additional studies confirm their finding, Huizar’s team says the guidelines for using clot-busters in people being treated for diabetes may need to be reconsidered.
Journal of the American College of Cardiology, September 17, 2003.
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FACT: Risk of cardiovascular disease begins at 115/75 mm Hg and doubles with each increment of 20/10 mm Hg. Individuals who have normal blood pressure at 5 years of age have a 90% lifetime risk of developing high blood pressure. Jour of the AMA, May 21, 2003