Chest pain due to reduced blood flow to the heart is called angina. Most often, angina results from the buildup of plaque in the coronary arteries that carry blood to the heart. Nitrate drugs (such as nitroglycerin) can alleviate angina when it occurs. Nitrates can also be used preventively before you engage in activities that are likely to cause chest pain, such as rapid walking or playing tennis. Many people with diabetes take a beta-blocker to treat high blood pressure; these drugs help to prevent angina as well.
If angina cannot be controlled with drug treatment, it's often a sign that you have severe blockages in one or more of your coronary arteries. When this happens, you may need angioplasty or bypass surgery to maintain adequate blood flow and prevent a heart attack.
Angioplasty involves inserting a catheter with a balloon at its tip into a femoral artery in your groin and guiding it to the narrowed portion of the coronary artery. The surgeon then inflates the balloon several times to squeeze the plaque against the wall of the artery, thus widening the artery opening and increasing blood flow to the heart. In most angioplasty procedures, a metal tube called a stent is placed in the artery to keep it propped open.
In bypass surgery, the surgeon connects a healthy artery in your chest to an area beyond the blocked portion of the coronary artery. Alternatively, the surgeon may remove a portion of one of your large leg veins and attach the vein on each side of the blocked area. Blood flow is then rerouted through this new blood vessel, "bypassing" the blockage.
The choice between angioplasty and bypass surgery depends on many factors, including how many blockages you have, the location of the blockages, and your overall health. Studies show an advantage for bypass surgery in people with diabetes who can withstand this major invasive procedure. One ongoing study of more than 1,800 people found that survival at seven years was significantly better with bypass surgery (74 percent) than with angioplasty (56%) for people with diabetes. However, recent developments in angioplasty, including the use of stents coated with drugs that prevent arteries from re-clogging, may make this alternative to bypass surgery an option for more people with diabetes.