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Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.

Abstract

BACKGROUND

Cardiovascular morbidity is a major burden in patients with type 2 diabetes. In the Steno-2 Study, we compared the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment on modifiable risk factors for cardiovascular disease in patients with type 2 diabetes and microalbuminuria.

METHODS

The primary end point of this open, parallel trial was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, revascularization, and amputation. Eighty patients were randomly assigned to receive conventional treatment in accordance with national guidelines and 80 to receive intensive treatment, with a stepwise implementation of behavior modification and pharmacologic therapy that targeted hyperglycemia, hypertension, dyslipidemia, and microalbuminuria, along with secondary prevention of cardiovascular disease with aspirin.

RESULTS

The mean age of the patients was 55.1 years, and the mean follow-up was 7.8 years. The decline in glycosylated hemoglobin values, systolic and diastolic blood pressure, serum cholesterol and triglyceride levels measured after an overnight fast, and urinary albumin excretion rate were all significantly greater in the intensive-therapy group than in the conventional-therapy group. Patients receiving intensive therapy also had a significantly lower risk of cardiovascular disease (hazard ratio, 0.47; 95 percent confidence interval, 0.24 to 0.73), nephropathy (hazard ratio, 0.39; 95 percent confidence interval, 0.17 to 0.87), retinopathy (hazard ratio, 0.42; 95 percent confidence interval, 0.21 to 0.86), and autonomic neuropathy (hazard ratio, 0.37; 95 percent confidence interval, 0.18 to 0.79).

CONCLUSIONS

A target-driven, long-term, intensified intervention aimed at multiple risk factors in patients with type 2 diabetes and microalbuminuria reduces the risk of cardiovascular and microvascular events by about 50 percent.

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  • Authors+Show Affiliations

    ,

    Steno Diabetes Center, Copenhagen, Denmark.

    , , , ,

    Source

    The New England journal of medicine 348:5 2003 Jan 30 pg 383-93

    MeSH

    Amputation
    Angiotensin II
    Angiotensin-Converting Enzyme Inhibitors
    Antihypertensive Agents
    Cardiovascular Diseases
    Combined Modality Therapy
    Diabetes Mellitus
    Diabetes Mellitus, Type 2
    Diet, Fat-Restricted
    Exercise
    Female
    Humans
    Hyperlipidemias
    Hypertension
    Hypoglycemic Agents
    Hypolipidemic Agents
    Male
    Middle Aged
    Myocardial Infarction
    Obesity
    Risk Factors
    Smoking Cessation
    Stroke
    Vitamins

    Pub Type(s)

    Clinical Trial
    Comparative Study
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    12556541

    Citation

    Gaede, Peter, et al. "Multifactorial Intervention and Cardiovascular Disease in Patients With Type 2 Diabetes." The New England Journal of Medicine, vol. 348, no. 5, 2003, pp. 383-93.
    Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348(5):383-93.
    Gaede, P., Vedel, P., Larsen, N., Jensen, G. V., Parving, H. H., & Pedersen, O. (2003). Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. The New England Journal of Medicine, 348(5), pp. 383-93.
    Gaede P, et al. Multifactorial Intervention and Cardiovascular Disease in Patients With Type 2 Diabetes. N Engl J Med. 2003 Jan 30;348(5):383-93. PubMed PMID: 12556541.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. AU - Gaede,Peter, AU - Vedel,Pernille, AU - Larsen,Nicolai, AU - Jensen,Gunnar V H, AU - Parving,Hans-Henrik, AU - Pedersen,Oluf, PY - 2003/1/31/pubmed PY - 2003/2/8/medline PY - 2003/1/31/entrez SP - 383 EP - 93 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 348 IS - 5 N2 - BACKGROUND: Cardiovascular morbidity is a major burden in patients with type 2 diabetes. In the Steno-2 Study, we compared the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment on modifiable risk factors for cardiovascular disease in patients with type 2 diabetes and microalbuminuria. METHODS: The primary end point of this open, parallel trial was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, revascularization, and amputation. Eighty patients were randomly assigned to receive conventional treatment in accordance with national guidelines and 80 to receive intensive treatment, with a stepwise implementation of behavior modification and pharmacologic therapy that targeted hyperglycemia, hypertension, dyslipidemia, and microalbuminuria, along with secondary prevention of cardiovascular disease with aspirin. RESULTS: The mean age of the patients was 55.1 years, and the mean follow-up was 7.8 years. The decline in glycosylated hemoglobin values, systolic and diastolic blood pressure, serum cholesterol and triglyceride levels measured after an overnight fast, and urinary albumin excretion rate were all significantly greater in the intensive-therapy group than in the conventional-therapy group. Patients receiving intensive therapy also had a significantly lower risk of cardiovascular disease (hazard ratio, 0.47; 95 percent confidence interval, 0.24 to 0.73), nephropathy (hazard ratio, 0.39; 95 percent confidence interval, 0.17 to 0.87), retinopathy (hazard ratio, 0.42; 95 percent confidence interval, 0.21 to 0.86), and autonomic neuropathy (hazard ratio, 0.37; 95 percent confidence interval, 0.18 to 0.79). CONCLUSIONS: A target-driven, long-term, intensified intervention aimed at multiple risk factors in patients with type 2 diabetes and microalbuminuria reduces the risk of cardiovascular and microvascular events by about 50 percent. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/12556541/full_citation L2 - https://www.nejm.org/doi/10.1056/NEJMoa021778?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=www.ncbi.nlm.nih.gov DB - PRIME DP - Unbound Medicine ER -