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Risk factor control for coronary artery disease secondary prevention in large randomized trials

Michael E Farkouh1, William E Boden, Vera Bittner

  • 1Mount Sinai School of Medicine, New York, New York 10029, USA.

Journal of the American College of Cardiology
|March 19, 2013
PubMed

Insights

Formalized risk factor control in clinical trials is insufficient for diabetic patients with coronary artery disease (CAD). Most patients with diabetes and CAD did not meet all four key treatment targets within a year, highlighting a need for new strategies.

Area of Science:

  • Cardiology
  • Diabetology
  • Clinical Trials

Background:

  • Coronary Artery Disease (CAD) secondary prevention offers proven benefits.
  • Risk factor control in clinical practice for CAD patients remains suboptimal.
  • Diabetic patients with CAD face particular challenges in achieving treatment goals.

Purpose of the Study:

  • To evaluate the effectiveness of formalized risk factor control in clinical trials for diabetic patients with CAD.
  • To determine if guideline-driven treatment targets can be achieved through structured interventions.
  • To assess the proportion of patients meeting targets for blood pressure, cholesterol, smoking cessation, and HbA1c.

Main Methods:

  • Data from three major federally funded trials (COURAGE, BARI 2D, FREEDOM) involving diabetic patients with CAD were analyzed.
  • The study focused on a pooled cohort of 5,034 patients.
  • Key outcome measures included achieving guideline-based targets for systolic blood pressure, LDL cholesterol, smoking cessation, and HbA1c at one year.

Main Results:

  • While LDL cholesterol control improved significantly across trials, only a small percentage of patients met all four risk factor targets.
  • The proportion of patients achieving all targets at one year was 18% in COURAGE, 23% in BARI 2D, and 8% in FREEDOM.
  • Trends for improved systolic blood pressure, glycemic control, and smoking cessation were observed, but overall target attainment was low.

Conclusions:

  • A substantial number of diabetic patients with CAD do not achieve guideline-recommended targets for major modifiable cardiovascular risk factors, even within clinical trials.
  • Current approaches to secondary prevention in this population are inadequate.
  • Novel strategies are urgently needed to improve risk factor management and optimize outcomes for diabetic CAD patients.
Abstract

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