Listening to doctors talking about the state of British medicine is about as cheering as hearing a group of farmers discussing the weather. Both will dwell on the disasters, the successes of neighbours and the failures of their own crops or patients. Doctors, with justification, bewail the shortage of beds and the shambles of medical education, and look with envy and anxiety at how British patients are doing compared with their Western European and American counterparts.

Few mention that a patient who had a group of common important cancers diagnosed 30 years ago had a 23.6 per cent chance of being alive after ten years, whereas now patients suffering from the same cancers have a 46.2 per cent chance of surviving a decade. Doctors don't mention that if we are not doing as well as some of our overseas colleagues, there has been a significant improvement in life expectancy in this country as well as in America and Western Europe.

Advances are being recorded not only in the treatment of malignant disease but also in the incidence and outcome of coronary arterial disease. There is a decline in the death rate and serious complications of coronary disease in men and women who have coronary arterial problems. There is, however, no decline in the death rate of patients who have both coronary arterial disease and diabetes type 2 (the type that doesn't usually need insulin and tends to attack those who are older, overweight, heavy-bellied and underexercised). Diabetes type 2 is becoming more common, and it seems clear from statistics that sufferers are more at risk from coronary arterial disease.

The British South Asian population, whose families originated in India and neighbouring countries, are especially at risk. They are three to four times more likely than their Caucasian neighbours to suffer from the unfortunate combination of atheromatous coronary heart disease and diabetes and consequently are much more likely to suffer rupture of an atheromatous fatty plaque in a coronary artery and, as a result, endure cardiac arrest, a coronary thrombosis or a stroke. Despite the overall advancement in diabetic and cardiac care there has been no great improvement in outcome after a heart attack suffered by diabetic patients.

This week encouraging evidence was given to the American College of Cardiology at the annual scientific session in Chicago that the addition of Actos pioglitazone to the standard medication regime for people with diabetes type 2 not only improves the control of their blood glucose levels but also improves the state of their coronary arteries by reducing the rate of complications and of the build-up of the potentially lethal fatty atheromatous plaques that have a liability to rupture.

Mark Kearney, Professor of Cardiology at the University of Leeds, says that the evidence given to the conference supports the theory that Actos pioglitazone has a beneficial effect on coronary atherosclerosis in patients with diabetes. Kearney says that the benefits of Actos are seen in addition to the advantages already afforded to patients having good treatment for heart disease and diabetes with statins and other cardiovascular and anti-diabetic drugs. Actos pioglitazone is an add-on treatment, an extra daily pill that might give diabetic patients with coronary arterial disease an improved outlook to that already experienced by people with coronary arterial disease without diabetes.

The effect of Actos on the atheroma, which is responsible for the premature death of 80 per cent of people with type 2 diabetes, was followed by means of intravascular ultrasound IVUS. By using this method the slowed progression of the furring-up of arteries with atheroma could be measured and its encouraging effect on reduction of the death rate, strokes and coronary arterial thromboses charted.

Dr Sarah Jarvis, a trustee of Heart UK and a well-known London GP, says that there is good evidence that the death rate in people with type 2 diabetes and heart disease can be kept down by careful control of their blood sugar, cholesterol levels and weight, but the present standard regime is inadequate to control type 2 diabetes when associated with heart disease.

She says that confirmation of the good results obtained in the Chicago study provide welcome reassurance to patients with heart disease and diabetes. Martin Cowie, Professor of Cardiology at the National Heart and Lung Institute, described the evidence from the trial of Actos pioglitazone: that it had a beneficial effect on the coronary arteries as well as good blood sugar control.

There are 2.75 million people in England with diabetes and it is estimated that there are another 500,000 whose diabetes has not yet been diagnosed. In the future many of these could expect to have a longer lifespan. Currently diabetes type 2 on average takes 15 years off life expectancy. If the problems of arterial disease could be eased, Actos may be part of the solution.