Multiple risk factor intervention and progression of coronary atherosclerosis in patients with type 2 diabetes mellitus

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dc.contributor.authorKataoka, Y.
dc.contributor.authorShao, M.
dc.contributor.authorWolski, K.
dc.contributor.authorUno, K.
dc.contributor.authorPuri, R.
dc.contributor.authorTuzcu, E.
dc.contributor.authorNissen, S.
dc.contributor.authorNicholls, S.
dc.date.issued2013
dc.description.abstractBACKGROUND: 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.
dc.description.statementofresponsibilityYu Kataoka, Mingyuan Shao, Kathy Wolski, Kiyoko Uno, Rishi Puri, E Murat Tuzcu, Steven E Nissen and Stephen J Nicholls
dc.identifier.citationEuropean Journal of Preventive Cardiology, 2013; 20(2):209-217
dc.identifier.doi10.1177/2047487312437931
dc.identifier.issn2047-4873
dc.identifier.issn2047-4881
dc.identifier.orcidPuri, R. [0000-0001-8849-7426]
dc.identifier.orcidNicholls, S. [0000-0002-9668-4368]
dc.identifier.urihttp://hdl.handle.net/2440/83177
dc.language.isoen
dc.publisherSage Publications Ltd
dc.rights© The European Society of Cardiology 2012
dc.source.urihttps://doi.org/10.1177/2047487312437931
dc.subjectDiabetes mellitus
dc.subjectmultiple risk factor intervention
dc.subjectintravascular ultrasound
dc.titleMultiple risk factor intervention and progression of coronary atherosclerosis in patients with type 2 diabetes mellitus
dc.typeJournal article
pubs.publication-statusPublished

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