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BARI 2D: A Reanalysis Focusing on Cardiovascular Events.
- Source :
-
Mayo Clinic proceedings [Mayo Clin Proc] 2019 Nov; Vol. 94 (11), pp. 2249-2262. Date of Electronic Publication: 2019 Oct 04. - Publication Year :
- 2019
-
Abstract
- Objective: To reanalyze the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial using a new composite cardiovascular disease (CVD) outcome to determine how best to treat patients with type 2 diabetes mellitus and stable coronary artery disease.<br />Patients and Methods: From January 1, 2001, to November 30, 2008, 2368 patients with type 2 diabetes mellitus and angiographically proven coronary artery disease were randomly assigned to insulin-sensitizing (IS) or insulin-providing (IP) therapy and simultaneously to coronary revascularization (REV) or no or delayed REV (intensive medical therapy [MED]), with all patients receiving intensive medical treatment. The outcome of this analysis was a composite of 8 CVD events.<br />Results: Four-year Kaplan-Meier rates for the composite CVD outcome were 35.8% (95% CI, 33.1%-38.5%) with IS therapy and 41.6% (95% CI, 38.7%-44.5%) with IP therapy (P=.004). Much of this difference was associated with lower in-trial levels of fibrinogen, C-reactive protein, and hemoglobin A <subscript>1c</subscript> with IS therapy. Four-year composite CVD rates were 32.7% (95% CI, 30.0%-35.4%) with REV and 44.7% (95% CI, 41.8%-47.6%) with MED (P<.001). A beneficial effect of IS vs IP therapy was present with REV (27.7%; 95% CI, 24.0%-31.4% vs 37.5%; 95% CI, 33.6%-41.4%; P<.001), but not with MED (43.6%; 95% CI, 39.5%-47.7% vs 45.7%; 95% CI, 41.6%-49.8%; P=.37) (homogeneity, P=.05). This interaction between IS therapy and REV was limited to participants preselected for coronary artery bypass grafting (CABG). The lowest composite CVD rates occurred in patients preselected for CABG and assigned to IS therapy and REV (17.3%; 95% CI, 11.8%-22.8%).<br />Conclusion: In the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial, the IS treatment strategy and the REV treatment strategy each reduces cardiovascular events. The combination of IS drugs and CABG results in the lowest risk of subsequent CVD events.<br />Trial Registration: clinicaltrials.gov Identifier: NCT00006305.<br /> (Copyright © 2019 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Angina, Stable
Coronary Artery Disease complications
Coronary Artery Disease drug therapy
Diabetes Mellitus, Type 2 complications
Diabetes Mellitus, Type 2 drug therapy
Female
Humans
Hypoglycemic Agents therapeutic use
Insulin Resistance
Male
Middle Aged
Treatment Outcome
Coronary Artery Bypass
Coronary Artery Disease therapy
Diabetes Mellitus, Type 2 therapy
Insulin therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1942-5546
- Volume :
- 94
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Mayo Clinic proceedings
- Publication Type :
- Academic Journal
- Accession number :
- 31590967
- Full Text :
- https://doi.org/10.1016/j.mayocp.2019.04.015