Comprehensive cardiovascular risk factor control improves survival

The BARI 2D trial

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

Research output: Contribution to journalArticle

57 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

Fingerprint

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

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Comprehensive cardiovascular risk factor control improves survival : The BARI 2D trial. / Bittner, Vera; Bertolet, Marnie; Barraza Felix, Rafael; Farkouh, Michael E.; Goldberg, Suzanne; Ramanathan, K; 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, K, 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, Vera ; Bertolet, Marnie ; Barraza Felix, Rafael ; Farkouh, Michael E. ; Goldberg, Suzanne ; Ramanathan, K ; 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.
@article{7f7a9fd003c24271b17e1cac67ce0c03,
title = "Comprehensive cardiovascular risk factor control improves survival: The BARI 2D trial",
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)",
author = "Vera Bittner and Marnie Bertolet and {Barraza Felix}, Rafael and Farkouh, {Michael E.} and Suzanne Goldberg and K Ramanathan and Redmon, {J. Bruce} and Laurence Sperling and Rutter, {Martin K.}",
year = "2015",
month = "8",
day = "18",
doi = "10.1016/j.jacc.2015.06.019",
language = "English (US)",
volume = "66",
pages = "765--773",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "7",

}

TY - JOUR

T1 - Comprehensive cardiovascular risk factor control improves survival

T2 - The BARI 2D trial

AU - Bittner, Vera

AU - Bertolet, Marnie

AU - Barraza Felix, Rafael

AU - Farkouh, Michael E.

AU - Goldberg, Suzanne

AU - Ramanathan, K

AU - Redmon, J. Bruce

AU - Sperling, Laurence

AU - Rutter, Martin K.

PY - 2015/8/18

Y1 - 2015/8/18

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)

UR - http://www.scopus.com/inward/record.url?scp=84939526817&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84939526817&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2015.06.019

DO - 10.1016/j.jacc.2015.06.019

M3 - Article

VL - 66

SP - 765

EP - 773

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 7

ER -