Modifications of coronary risk factors

Area of Science:

• Cardiology
• Metabolic Disorders
• Public Health

Background:

• Coronary artery disease (CAD) risk factor management is crucial in diabetic patients.
• The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial aimed to optimize CAD risk factor control.
• Standardized management of dyslipidemia, hypertension, obesity, and lifestyle factors is essential.

Purpose of the Study:

• To implement and monitor uniform control of major coronary artery disease risk factors in diabetic patients.
• To adapt target risk factor levels according to evolving clinical practice guidelines throughout the trial.
• To develop and apply algorithms for pharmacologic and non-pharmacologic interventions.

Main Methods:

• Interventions included revascularization, glycemic control, and uniform management of dyslipidemia, hypertension, smoking, obesity, and sedentary lifestyle.
• Pharmacologic management algorithms were developed for lipids and hypertension.
• Dietary prescriptions and individually adapted exercise programs (endurance, resistance/flexibility) were implemented, with pedometers for biofeedback.

Main Results:

• Target goals were set for LDL cholesterol (<2.59 mmol/L), triglycerides (<1.70 mmol/L), and blood pressure (<130/80 mm Hg).
• Smoking cessation treatment was provided to all active smokers.
• A lifestyle weight-management program and exercise prescriptions were instituted.

Conclusions:

• The BARI 2D trial established a comprehensive strategy for managing multiple CAD risk factors in diabetic patients.
• Working groups designed and monitored the implementation of risk factor control strategies.
• The study adapted interventions to patient needs and evolving clinical guidelines.