The mailbag

A comment was received from reader Jan which goes like this:

I just did a stress test today on a 42 year old who had CABG at 35. He has been a type I diabetic since he was 20. Even adding the 15 years to make him cardiovascularly 50 when he had his surgery, he would still be considered to have premature CAD.

Did GSK say anything about creating at TZD drug that does not contribute to volume overload and CHF? Many patients with heart failure cannot be on metformin due to renal insufficiency, also have had several pts have CHF precipitated by Avandia and related drugs. Unfortunately these patients then end up on higher and higher doses of insulin resulting in more weight gain and the cycle goes on.

Thank you for the comment...

Yes, you are right, thiaglitazones have a problem of fluid retention and volume overload. And, no, GSK does have any drug that fits your profile, at least not to my knowledge.

I hope your patient's stress ECG is good, with no stress induced myocardial ischemia. I would suggest also that you put him on a ACE-i or ARB, a statin and also an anti-platelet agent. I know it is poly-pharmacy, but the state of knowledge now seems to imply that these are good for your patient.

Keep those comments coming. We are particularly encouraged by comments to the case studies and will post some next.