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Type: Journal article
Title: Multiple risk factor intervention and progression of coronary atherosclerosis in patients with type 2 diabetes mellitus
Author: Kataoka, Y.
Shao, M.
Wolski, K.
Uno, K.
Puri, R.
Tuzcu, E.
Nissen, S.
Nicholls, S.
Citation: European Journal of Cardiovascular Prevention and Rehabilitation, 2013; 20(2):209-217
Publisher: Sage Publications Ltd
Issue Date: 2013
ISSN: 2047-4873
Statement of
Yu Kataoka, Mingyuan Shao, Kathy Wolski, Kiyoko Uno, Rishi Puri, E Murat Tuzcu, Steven E Nissen and Stephen J Nicholls
Abstract: BACKGROUND: Diabetic patients with coronary artery disease (CAD) demonstrate accelerated progression of coronary atherosclerosis. The impact of multiple risk factor intervention on disease progression has not been investigated. DESIGN: We investigated 448 diabetic patients with angiographic CAD who underwent serial intravascular ultrasound imaging to monitor the change in atheroma burden in seven clinical trials. METHODS: Disease progression was compared in patients stratified according to whether they achieved increasing numbers of treatment goals of individual risk factors (HbA1c <7.0%, LDL cholesterol <2.5 mmol/l, triglyceride <1.7 mmol/l, systolic blood pressure <130 mmHg, high sensitivity C-reactive protein <2.0 mg/l). RESULTS: A high rate of established medical therapies was used in all patients (89% statins, 94% aspirin, 76% β-blockers, 66% ACE inhibitors, 66% metformin, 62% thiazolidinediones, 17% insulin). No differences were observed with regard to percentage atheroma volume (PAV) and total atheroma volume (TAV) at baseline. On serial evaluation, slowing of progression of PAV (p = 0.01) and TAV (p  < 0.001) was observed with increasing numbers of risk factors achieving treatment goals. On multivariate analysis adjusting for baseline risk factors, increasing the number of factors meeting treatment goals continued to be associated with a beneficial impact on progression of PAV (p = 0.03) and TAV (p < 0.001). CONCLUSION: The benefit of achieving optimal control of multiple risk factors underscores the need for modification of global risk in patients with diabetes.
Keywords: Diabetes mellitus
multiple risk factor intervention
intravascular ultrasound
Rights: © The European Society of Cardiology 2012
DOI: 10.1177/2047487312437931
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