Abstract 12663: Risk Factor Control in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial
Introduction: Achievement of guideline-specified treatment goals for cardiovascular risk factors is increasingly used for performance evaluation / reimbursement. In clinical practice, only a minority of individuals with diabetes achieve optimal control of multiple risk factors. Hypothesis: Comprehensive treatment in the BARI 2D trial will significantly increase the proportion of individuals who achieve multiple treatment goals.
Methods: BARI 2D evaluated the efficacy of coronary revascularization on a background of protocol-guided aggressive medical therapy among patients with diabetes including frequent lifestyle advice from study personnel and intensification of medications based on frequent risk factor reassessment. We computed mean changes in risk factors and proportion of participants at treatment goals over 5 years of follow-up for smoking status, LDL-C (<100 mg/dL ), non-HDL-C (<130 mg/dL), triglycerides (TG) (<150 mg/dL), systolic blood pressure [SBP] (<130 mmHg) and diastolic blood pressure [DBP] (<80 mmHg). Proportions beyond baseline were compared by linear trend testing, using year of ascertainment as a continuous variable.
Results: From baseline to 5 years, LDL-C decreased from 96 (33) to 77 (28) mg/dL, non-HDL-C from 131 (41) to 106 (36) mg/dL, TG from 181 (135) to 147 (124) mg/dL, SBP from 132 (20) to 126 (16) mmHg and DBP from 74 (11) to 68 (10) mmHg. [all p<0.0001] Proportion of individuals at risk factor goals over time did not vary by trial treatment allocation. The mean number of risk factors at goal per patient increased from 3.7 (1.4) at baseline to 4.7 (1.2) at 5 years.
Conclusion: Using aggressive medical therapy, individual treatment goals are achievable in a large proportion of patients with diabetes enrolled in a clinical trial focused on such therapy. Even in this idealized setting, control of multiple risk factors is only achieved in a minority of patients. Our results may be useful in setting expectations in pay for performance settings.
- © 2010 by American Heart Association, Inc.