Avandia in Perspective

People with diabetes face hazards aplenty, among them twice the normal risk of heart disease and stroke and up to four times the chance of a fatal heart-related event. Last May, several million diabetic patients taking Avandia to control their blood sugar heard about a study suggesting that the drug raises their heart-attack risk by more than 40 percent. Earlier this month, another study echoed that finding.

Diabetics can improve their blood sugar and decrease risk of heart attack with exercise.

That's obviously not good. But the increased risk may be less threatening than it sounds, and diabetic individuals have the means at hand to counter it.

Because the existing heart-attack risk for a typical diabetes patient is low—about 1.1 percent a year—Avandia boosts the risk only to about 1.5 percent. So there's still a 98.5 percent likelihood of not having a heart attack. (Actos, a similar medication, for some reason seems to trim the rate of heart attack and stroke, fatal and nonfatal.)

Both drugs, however, pose a significant risk of heart failure, or reduced cardiac function. "That's getting missed in the news coverage," says Sonal Singh, an assistant professor at Wake Forest University School of Medicine and lead author of this month's Avandia study. In much of Europe, he notes, patients with any degree of heart failure don't get such drugs, while in the United States their use is discouraged only for patients with severe heart failure.

Another perspective on drug risk is a comparison with risks diabetes patients can reduce on their own:

1. Smoking. Even one to five cigarettes a day raises the risk of heart disease in diabetic women by 40 percent. Going to 15 a day boosts the risk by 168 percent.

2. Inactivity. A study found diabetic nonexercisers had a 34 percent higher risk of fatal heart attack or stroke than diabetic patients who walked at least two hours a week. And in a trial reported this month, diabetic patients improved their blood sugar after 22 weeks of aerobic and resistance training.

3. Obesity. Almost 80 percent of those with type 2 diabetes carry too much weight. In June, one-year results from an ongoing study showed improved blood sugar control, blood pressure, and cholesterol in 2,500 diabetic patients, almost all of them obese, who lost an average of 9 percent of their weight and became physically active.

It's hard to change, grants internist Leonard Egede, who sees many diabetes patients at the Medical University of South Carolina: "When people into my clinic, they say, 'I know I need to lose weight, I know I need to exercise.' They want to do it...but they're unable to maintain the effort." Yet sustained effort pays off: Many of those 2,500 patients were able to toss their diabetes medications.