Abstract 14103: Comprehensive Risk Factor Control Improves Survival: The Bypass Angioplasty Revascularization Investigation 2 Diabetes
Introduction: BARI 2D evaluated the efficacy of prompt coronary revascularization on a background of protocol-guided aggressive medical therapy (AMT) among patients with Type 2 diabetes including frequent lifestyle advice and intensification of medications based on frequent cardiovascular risk factor (CVRF) reassessment. Modification of individual CVRF through lifestyle change and medications improves prognosis among patients with CHD. Few prospective studies have addressed whether simultaneous achievement of guideline-specified treatment targets for multiple CVRF relates to survival.
Hypothesis: Achievement of multiple CVRF goals through protocol-guided AMT is associated with survival in the BARI 2D trial.
Methods: We analyzed the non-randomized relationship between survival and control of 7 CVRF [smoking status, LDL-C (<100 mg/dL), non-HDL-C (<130 mg/dL), triglycerides (<150 mg/dL), systolic blood pressure (<130 mmHg), diastolic blood pressure (<80 mmHg), hemoglobin A1C (<7%)]. CVRFs were measured monthly for the first six months, quarterly thereafter. Survival was modeled using a Cox analysis with time-varying number of CVRF in control and adjusted for age, sex, race, region, BARI 2D randomization assignments, baseline ejection fraction, prior revascularization, and severity of coronary artery disease at baseline. The number of CVRF in control was modeled a) continuously and b) categorically (reference 0-2 CVRF in control) allowing for a non-linear relationship.
Results: The analysis included 2,265 patients (46,733 visits, average follow-up 5 years). Mean age was 62.3 years, 29.3% were women, 34.2% non-white. The 5-year Kaplan Meier survival rate was 89.2%. Multi-variably adjusted hazard ratios and 95% confidence intervals from Cox regression models are shown in the table.
Conclusion: Simultaneous control of multiple CVRF through protocol-guided AMT strongly relates to survival among patients with CHD and Type 2 diabetes.
- © 2011 by American Heart Association, Inc.