What should you do if your doctor tells you that you have blocked coronary arteries? A recent study shows that in people who have blocked arteries and diabetes, the chances of dying or having a major heart attack are the same whether they undergo surgical procedures (bypass or stents) or just take medication to treat cholesterol, blood pressure and diabetes. Death rate was also the same whether or not they took insulin (BARI 2D study, New England Journal of Medicine, June 10, 2009).

Patients who had bypass procedures had fewer heart attacks than those who had stents, even though both had the same chances of dying (also reported in the BARI-1 trial). I think that stents are less effective in preventing heat attacks because stents are foreign bodies placed in arteries that can increase chances of clotting, a major precipitating cause of heart attacks. That is why people with stents are given drugs to prevent clotting. Also, type 2 diabetics who were not given insulin had fewer blockages than those given insulin. I think that this is because high insulin levels constricts coronary arteries.

This is a very important study because the most common cause of a sudden heart attack is diabetes, and 80 percent of diabetics die of heart disease. More than one third of Americans will become diabetic and that number is projected to double by 2030.

If you have diabetes and blocked arteries, try to avoid surgery. If you need surgery, you may gain better protection from a bypass than from a stent. I also believe that you should try to control type II diabetes without insulin. Get a blood test called C peptide (which measures insulin production). If it is above one, try to avoid insulin. If it is below one, or you cannot get your HBA1C blood test (which measures cellular damage from diabetes) below 6.5, you may need insulin.

For everyone, I recommend: 1) A diet rich in fruits, vegetables, whole grains, beans, seeds and nuts. Restrict meat from mammals, and eat refined carbohydrates (sugar water and flour) only when exercising. 2) Exercise every day, and avoid overweight, smoking and more than two alcoholic drinks a day. 3) Keep blood levels of vitamin D3 above 75 nmol/L.