Comprehensive Cardiovascular Risk Factor Control Improves Survival

• Published in: Journal of the American College of Cardiology Vol. 66; no. 7; pp. 765 - 773
• Main Authors: Bittner, Vera, MD, MSPH, Bertolet, Marnie, PhD, Barraza Felix, Rafael, MD, Farkouh, Michael E., MD, MSc, Goldberg, Suzanne, RN, MSN, Ramanathan, Kodangudi B., MD, Redmon, J. Bruce, MD, Sperling, Laurence, MD, Rutter, Martin K., MD
• Format: Journal Article
• Language: English
• Published: New York Elsevier Inc 18.08.2015; Elsevier Limited
• Subjects: blood pressure; Cardiology; Cardiovascular; Cardiovascular disease; Cholesterol; coronary heart disease; diabetes mellitus; glycosylated hemoglobin A; Heart attacks; Internal Medicine; smoking; blood pressure; cardiovascular disease; T2DM; myocardial infarction; diabetes mellitus; risk factor; BP; CVD; glycosylated hemoglobin A; HbA 1c; RF; smoking; type 2 diabetes mellitus; cholesterol; coronary heart disease; glycosylated hemoglobin; MI; CHD; non-HDL-C; non-high-density lipoprotein cholesterol; HbA1c
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2015.06.019

Abstract Background It is unclear whether achieving multiple risk factor (RF) goals through protocol-guided intensive medical therapy is feasible or improves outcomes in type 2 diabetes mellitus. Objectives This study sought to quantify the relationship between achieved RF goals in the BARI 2D (Bypass Angioplasty Investigation Revascularization 2 Diabetes) trial and cardiovascular events/survival. Methods We performed a nonrandomized analysis of survival/cardiovascular events and control of 6 RFs (no smoking, non–high-density lipoprotein cholesterol <130 mg/dl, triglycerides <150 mg/dl, blood pressure [systolic <130 mm Hg; diastolic <80 mm Hg], glycosylated hemoglobin <7%) in BARI 2D. Cox models with time-varying number of RFs in control were adjusted for baseline number of RFs in control, clinical characteristics, and trial randomization assignments. Results In 2,265 patients (mean age 62 years, 29% women) followed up for 5 years, the mean ± SD number of RFs in control improved from 3.5 ± 1.4 at baseline to 4.2 ± 1.3 at 5 years (p < 0.0001). The number of RFs in control during the trial was strongly related to death (global p = 0.0010) and the composite of death, myocardial infarction, and stroke (global p = 0.0035) in fully adjusted models. Participants with 0 to 2 RFs in control during follow-up had a 2-fold higher risk of death (hazard ratio: 2.0; 95% confidence interval: 1.3 to 3.3; p = 0.0031) and a 1.7-fold higher risk of the composite endpoint (hazard ratio: 1.7; 95% confidence interval: 1.2 to 2.5; p = 0.0043), compared with those with 6 RFs in control. Conclusions Simultaneous control of multiple RFs through protocol-guided intensive medical therapy is feasible and relates to cardiovascular morbidity and mortality in patients with coronary disease and type 2 diabetes mellitus. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes [BARI 2D]; NCT00006305 )