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Intensive medical therapy controls risk factors, improves outcomes in diabetes, CHD
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Through protocol-guided intensive medical therapy, clinicians were able to achieve simultaneous control of multiple risk factors in patients with diabetes and CHD, which led to reduced risk for death, MI and stroke, according to new findings from the BARI 2D study.
Researchers performed a nonrandomized analysis of 2,265 patients (mean age, 62 years; 29% women) from the BARI 2D study of patients with type 2 diabetes and angiographically documented stable CHD. The outcomes of interest were death and a composite of death, MI and stroke as related to control of six risk factors: smoking cessation, non-HDL less than 130 mg/dL, triglycerides less than 150 mg/dL, systolic BP less than 130 mm Hg, diastolic BP less than 80 mm Hg and HbA1c less than 7%.
Risk factor management
During 5 years of follow-up, the mean number of risk factors in control improved from 3.5 at baseline to 4.2, Vera Bittner, MD, MSPH, from the division of cardiovascular disease of the department of medicine at the University of Alabama at Birmingham, and colleagues reported. The number of controlled risk factors during the study period was strongly correlated to death (P = .001) and death/MI/stroke (P = .0035) after adjustment.
Vera Bittner
Compared with patients who had all six risk factors in control during the trial, those with two or fewer risk factors in control had a higher risk for death (HR = 2; 95% CI, 1.3-3.3) and death/MI/stroke (HR = 1.7; 95% CI, 1.2-2.5), according to the researchers.
“To our knowledge, this study is the first among patients with [type 2 diabetes] and CHD to show a strong association between the number of [risk factors] below predetermined target levels and clinical outcomes,” Bittner, a member of the Cardiology Today Editorial Board, and colleagues wrote. “These observational data suggest that patients with CHD and [type 2 diabetes] require multiple [risk factor] interventions, including management of systolic BP and HbA1c, to avoid undertreatment and overtreatment.”
Risk factor control impacts survival
“The remarkable observation of the present report is the significantly better survival (a 50% lower mortality rate) among patients who achieved good risk factor control in a trial that found no survival benefit from revascularization,” David J. Maron, MD, from the division of cardiovascular medicine of the department of medicine at Stanford University School of Medicine, and William E. Boden, MD, from the department of medicine at the Samuel A. Stratton VA Medical Center, Albany Medical Center and Albany Medical College, Albany, New York, wrote in an accompanying editorial.
According to Maron and Boden, “These data are compelling and argue persuasively that all patients with [stable ischemic heart disease] should receive [optimal medical therapy], regardless of whether they undergo revascularization.” – by Erik Swain
Disclosures: The study was funded in part by Abbott Laboratories, Astellas Pharma US, GlaxoSmithKline, Lanceus Medical Imaging, Merck and Pfizer, with additional support from Abbott, Bayer Diagnostics, Becton Dickinson, J.R. Carlson Labs, Centocor, Eli Lilly, LipoScience, MediSense Products, Merck Sante, Novartis and Novo Nordisk. Bittner reports receiving research funding from Bayer, Janssen Pharmaceuticals, Pfizer and Sanofi and serving on advisory panels for Amgen and Eli Lilly. See the full study for relevant financial disclosures of other researchers and the editorial for relevant financial disclosures of Maron and Boden.
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