Comprehensive cardiovascular risk factor control improves survival

The BARI 2D trial

Vera Bittner, Marnie Bertolet, Rafael Barraza Felix, Michael E. Farkouh, Suzanne Goldberg, Kodangudi B. Ramanathan, J. Bruce Redmon, Laurence Sperling, Martin K. Rutter

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Background It is unclear whether achieving multiple risk factor (RF) goals through protocol-guided intensive medical therapy is feasible or improves outcomes in type 2 diabetes mellitus. Objectives This study sought to quantify the relationship between achieved RF goals in the BARI 2D (Bypass Angioplasty Investigation Revascularization 2 Diabetes) trial and cardiovascular events/survival. Methods We performed a nonrandomized analysis of survival/cardiovascular events and control of 6 RFs (no smoking, non-high-density lipoprotein cholesterol <130 mg/dl, triglycerides <150 mg/dl, blood pressure [systolic <130 mm Hg; diastolic <80 mm Hg], glycosylated hemoglobin <7%) in BARI 2D. Cox models with time-varying number of RFs in control were adjusted for baseline number of RFs in control, clinical characteristics, and trial randomization assignments. Results In 2,265 patients (mean age 62 years, 29% women) followed up for 5 years, the mean ± SD number of RFs in control improved from 3.5 ± 1.4 at baseline to 4.2 ± 1.3 at 5 years (p < 0.0001). The number of RFs in control during the trial was strongly related to death (global p = 0.0010) and the composite of death, myocardial infarction, and stroke (global p = 0.0035) in fully adjusted models. Participants with 0 to 2 RFs in control during follow-up had a 2-fold higher risk of death (hazard ratio: 2.0; 95% confidence interval: 1.3 to 3.3; p = 0.0031) and a 1.7-fold higher risk of the composite endpoint (hazard ratio: 1.7; 95% confidence interval: 1.2 to 2.5; p = 0.0043), compared with those with 6 RFs in control. Conclusions Simultaneous control of multiple RFs through protocol-guided intensive medical therapy is feasible and relates to cardiovascular morbidity and mortality in patients with coronary disease and type 2 diabetes mellitus. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes [BARI 2D]; NCT00006305)

Original languageEnglish (US)
Pages (from-to)765-773
Number of pages9
JournalJournal of the American College of Cardiology
Volume66
Issue number7
DOIs
StatePublished - Aug 18 2015

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Angioplasty
Type 2 Diabetes Mellitus
Survival
Confidence Intervals
Glycosylated Hemoglobin A
Survival Analysis
Random Allocation
Proportional Hazards Models
Coronary Disease
Triglycerides
Smoking
Stroke
Myocardial Infarction
Clinical Trials
Blood Pressure
Morbidity
Mortality
Therapeutics

Keywords

  • blood pressure
  • cholesterol
  • coronary heart disease
  • diabetes mellitus
  • glycosylated hemoglobin A
  • smoking

Cite this

Bittner, V., Bertolet, M., Barraza Felix, R., Farkouh, M. E., Goldberg, S., Ramanathan, K. B., ... Rutter, M. K. (2015). Comprehensive cardiovascular risk factor control improves survival: The BARI 2D trial. Journal of the American College of Cardiology, 66(7), 765-773. https://doi.org/10.1016/j.jacc.2015.06.019

Comprehensive cardiovascular risk factor control improves survival : The BARI 2D trial. / Bittner, Vera; Bertolet, Marnie; Barraza Felix, Rafael; Farkouh, Michael E.; Goldberg, Suzanne; Ramanathan, Kodangudi B.; Redmon, J. Bruce; Sperling, Laurence; Rutter, Martin K.

In: Journal of the American College of Cardiology, Vol. 66, No. 7, 18.08.2015, p. 765-773.

Research output: Contribution to journalArticle

Bittner, V, Bertolet, M, Barraza Felix, R, Farkouh, ME, Goldberg, S, Ramanathan, KB, Redmon, JB, Sperling, L & Rutter, MK 2015, 'Comprehensive cardiovascular risk factor control improves survival: The BARI 2D trial', Journal of the American College of Cardiology, vol. 66, no. 7, pp. 765-773. https://doi.org/10.1016/j.jacc.2015.06.019
Bittner V, Bertolet M, Barraza Felix R, Farkouh ME, Goldberg S, Ramanathan KB et al. Comprehensive cardiovascular risk factor control improves survival: The BARI 2D trial. Journal of the American College of Cardiology. 2015 Aug 18;66(7):765-773. https://doi.org/10.1016/j.jacc.2015.06.019
Bittner, Vera ; Bertolet, Marnie ; Barraza Felix, Rafael ; Farkouh, Michael E. ; Goldberg, Suzanne ; Ramanathan, Kodangudi B. ; Redmon, J. Bruce ; Sperling, Laurence ; Rutter, Martin K. / Comprehensive cardiovascular risk factor control improves survival : The BARI 2D trial. In: Journal of the American College of Cardiology. 2015 ; Vol. 66, No. 7. pp. 765-773.
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abstract = "Background It is unclear whether achieving multiple risk factor (RF) goals through protocol-guided intensive medical therapy is feasible or improves outcomes in type 2 diabetes mellitus. Objectives This study sought to quantify the relationship between achieved RF goals in the BARI 2D (Bypass Angioplasty Investigation Revascularization 2 Diabetes) trial and cardiovascular events/survival. Methods We performed a nonrandomized analysis of survival/cardiovascular events and control of 6 RFs (no smoking, non-high-density lipoprotein cholesterol <130 mg/dl, triglycerides <150 mg/dl, blood pressure [systolic <130 mm Hg; diastolic <80 mm Hg], glycosylated hemoglobin <7{\%}) in BARI 2D. Cox models with time-varying number of RFs in control were adjusted for baseline number of RFs in control, clinical characteristics, and trial randomization assignments. Results In 2,265 patients (mean age 62 years, 29{\%} women) followed up for 5 years, the mean ± SD number of RFs in control improved from 3.5 ± 1.4 at baseline to 4.2 ± 1.3 at 5 years (p < 0.0001). The number of RFs in control during the trial was strongly related to death (global p = 0.0010) and the composite of death, myocardial infarction, and stroke (global p = 0.0035) in fully adjusted models. Participants with 0 to 2 RFs in control during follow-up had a 2-fold higher risk of death (hazard ratio: 2.0; 95{\%} confidence interval: 1.3 to 3.3; p = 0.0031) and a 1.7-fold higher risk of the composite endpoint (hazard ratio: 1.7; 95{\%} confidence interval: 1.2 to 2.5; p = 0.0043), compared with those with 6 RFs in control. Conclusions Simultaneous control of multiple RFs through protocol-guided intensive medical therapy is feasible and relates to cardiovascular morbidity and mortality in patients with coronary disease and type 2 diabetes mellitus. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes [BARI 2D]; NCT00006305)",
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AU - Goldberg, Suzanne

AU - Ramanathan, Kodangudi B.

AU - Redmon, J. Bruce

AU - Sperling, Laurence

AU - Rutter, Martin K.

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N2 - Background It is unclear whether achieving multiple risk factor (RF) goals through protocol-guided intensive medical therapy is feasible or improves outcomes in type 2 diabetes mellitus. Objectives This study sought to quantify the relationship between achieved RF goals in the BARI 2D (Bypass Angioplasty Investigation Revascularization 2 Diabetes) trial and cardiovascular events/survival. Methods We performed a nonrandomized analysis of survival/cardiovascular events and control of 6 RFs (no smoking, non-high-density lipoprotein cholesterol <130 mg/dl, triglycerides <150 mg/dl, blood pressure [systolic <130 mm Hg; diastolic <80 mm Hg], glycosylated hemoglobin <7%) in BARI 2D. Cox models with time-varying number of RFs in control were adjusted for baseline number of RFs in control, clinical characteristics, and trial randomization assignments. Results In 2,265 patients (mean age 62 years, 29% women) followed up for 5 years, the mean ± SD number of RFs in control improved from 3.5 ± 1.4 at baseline to 4.2 ± 1.3 at 5 years (p < 0.0001). The number of RFs in control during the trial was strongly related to death (global p = 0.0010) and the composite of death, myocardial infarction, and stroke (global p = 0.0035) in fully adjusted models. Participants with 0 to 2 RFs in control during follow-up had a 2-fold higher risk of death (hazard ratio: 2.0; 95% confidence interval: 1.3 to 3.3; p = 0.0031) and a 1.7-fold higher risk of the composite endpoint (hazard ratio: 1.7; 95% confidence interval: 1.2 to 2.5; p = 0.0043), compared with those with 6 RFs in control. Conclusions Simultaneous control of multiple RFs through protocol-guided intensive medical therapy is feasible and relates to cardiovascular morbidity and mortality in patients with coronary disease and type 2 diabetes mellitus. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes [BARI 2D]; NCT00006305)

AB - Background It is unclear whether achieving multiple risk factor (RF) goals through protocol-guided intensive medical therapy is feasible or improves outcomes in type 2 diabetes mellitus. Objectives This study sought to quantify the relationship between achieved RF goals in the BARI 2D (Bypass Angioplasty Investigation Revascularization 2 Diabetes) trial and cardiovascular events/survival. Methods We performed a nonrandomized analysis of survival/cardiovascular events and control of 6 RFs (no smoking, non-high-density lipoprotein cholesterol <130 mg/dl, triglycerides <150 mg/dl, blood pressure [systolic <130 mm Hg; diastolic <80 mm Hg], glycosylated hemoglobin <7%) in BARI 2D. Cox models with time-varying number of RFs in control were adjusted for baseline number of RFs in control, clinical characteristics, and trial randomization assignments. Results In 2,265 patients (mean age 62 years, 29% women) followed up for 5 years, the mean ± SD number of RFs in control improved from 3.5 ± 1.4 at baseline to 4.2 ± 1.3 at 5 years (p < 0.0001). The number of RFs in control during the trial was strongly related to death (global p = 0.0010) and the composite of death, myocardial infarction, and stroke (global p = 0.0035) in fully adjusted models. Participants with 0 to 2 RFs in control during follow-up had a 2-fold higher risk of death (hazard ratio: 2.0; 95% confidence interval: 1.3 to 3.3; p = 0.0031) and a 1.7-fold higher risk of the composite endpoint (hazard ratio: 1.7; 95% confidence interval: 1.2 to 2.5; p = 0.0043), compared with those with 6 RFs in control. Conclusions Simultaneous control of multiple RFs through protocol-guided intensive medical therapy is feasible and relates to cardiovascular morbidity and mortality in patients with coronary disease and type 2 diabetes mellitus. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes [BARI 2D]; NCT00006305)

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