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Comprehensive Cardiovascular Risk Factor Control Improves Survival: The BARI 2D Trial
Vera Bittner1, Marnie Bertolet2, Rafael Barraza Felix3
1Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Journal of the American College of Cardiology
|August 14, 2015
Summary
Achieving multiple risk factor goals in type 2 diabetes is feasible and significantly reduces cardiovascular events and mortality. Intensive medical therapy improved risk factor control, lowering death and major adverse cardiovascular events.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Trials
Background:
- The feasibility and impact of achieving multiple risk factor (RF) goals via intensive medical therapy in type 2 diabetes mellitus (T2DM) remain unclear.
- Protocol-guided management aims to improve cardiovascular outcomes in T2DM patients.
Purpose of the Study:
- To assess the relationship between achieving multiple risk factor goals and cardiovascular events/survival in the BARI 2D trial.
- Quantify the impact of risk factor control on morbidity and mortality in T2DM with coronary disease.
Main Methods:
- Nonrandomized analysis of cardiovascular events and survival in 2,265 BARI 2D participants.
- Examined control of 6 risk factors (smoking, cholesterol, triglycerides, blood pressure, HbA1c) using Cox models with time-varying covariates.
Main Results:
- Mean number of controlled risk factors improved from 3.5 to 4.2 over 5 years (p < 0.0001).
- Greater risk factor control was strongly associated with reduced death (p=0.0010) and composite cardiovascular events (p=0.0035).
- Patients with 0-2 controlled RFs had double the risk of death and 1.7x risk of composite events compared to those with 6 controlled RFs.
Conclusions:
- Simultaneous control of multiple risk factors is feasible in patients with coronary disease and T2DM.
- Protocol-guided intensive medical therapy is linked to improved cardiovascular morbidity and mortality outcomes.
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