OBJECTIVES: Cardiovascular disease prevention for patients with type 2 diabetes is accomplished through hypertension and dyslipidemia management. Although studies have established strategies for lowering low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP), none have examined whether glycemia influences ability to achieve lipid and BP targets. This post hoc analysis from the Stop Atherosclerosis in Native Diabetics Study examines the role of baseline glycemia in achieving standard and aggressive targets and outcomes after 36 months. METHODS:Diabetic individuals aged > 40 years with no cardiovascular events (n = 499) were randomized to aggressive versus standard targets for LDL-C, non-high-density lipoprotein cholesterol (non-HDL-C) and systolic BP (SBP). Management algorithms were used for both groups. Carotid ultrasound and echocardiography were performed at baseline and after 36 months. RESULTS: No differences were observed in baseline hemoglobin A1c between treatment groups nor any significant change in A1c after 36 months in either group. Baseline A1c, however, was significantly and negatively related to achieving LDL-C (P = .007), non-HDL-C (P = .03) and SBP targets (P = .007) and to changes in LDL-C (P = .007), non-HDL-C (P = .03) and SBP (P = .001) in both groups. Baseline A1c failed to predict progression of carotid intima medial thickness (CIMT) (P = .42) or left ventricular mass index (LVMI) (P = .10), nor was it related to the effects of lipid and BP lowering on CIMT and LVMI over 36 months. CONCLUSIONS: In diabetic adults with no cardiovascular disease events, A1c was negatively associated with ability to achieve LDL-C, non-HDL-C and SBP goals but was not independently related to treatment-associated changes in CIMT or LVMI over 36 months.
RCT Entities:
OBJECTIVES:Cardiovascular disease prevention for patients with type 2 diabetes is accomplished through hypertension and dyslipidemia management. Although studies have established strategies for lowering low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP), none have examined whether glycemia influences ability to achieve lipid and BP targets. This post hoc analysis from the Stop Atherosclerosis in Native Diabetics Study examines the role of baseline glycemia in achieving standard and aggressive targets and outcomes after 36 months. METHODS:Diabetic individuals aged > 40 years with no cardiovascular events (n = 499) were randomized to aggressive versus standard targets for LDL-C, non-high-density lipoprotein cholesterol (non-HDL-C) and systolic BP (SBP). Management algorithms were used for both groups. Carotid ultrasound and echocardiography were performed at baseline and after 36 months. RESULTS: No differences were observed in baseline hemoglobin A1c between treatment groups nor any significant change in A1c after 36 months in either group. Baseline A1c, however, was significantly and negatively related to achieving LDL-C (P = .007), non-HDL-C (P = .03) and SBP targets (P = .007) and to changes in LDL-C (P = .007), non-HDL-C (P = .03) and SBP (P = .001) in both groups. Baseline A1c failed to predict progression of carotid intima medial thickness (CIMT) (P = .42) or left ventricular mass index (LVMI) (P = .10), nor was it related to the effects of lipid and BP lowering on CIMT and LVMI over 36 months. CONCLUSIONS: In diabetic adults with no cardiovascular disease events, A1c was negatively associated with ability to achieve LDL-C, non-HDL-C and SBP goals but was not independently related to treatment-associated changes in CIMT or LVMI over 36 months.
Authors: Ying Zhang; James M Galloway; Thomas K Welty; David O Wiebers; Jack P Whisnant; Richard B Devereux; Jorge R Kizer; Barbara V Howard; Linda D Cowan; Jeunliang Yeh; W James Howard; Wenyu Wang; Lyle Best; Elisa T Lee Journal: Circulation Date: 2008-09-22 Impact factor: 29.690
Authors: Jay S Skyler; Richard Bergenstal; Robert O Bonow; John Buse; Prakash Deedwania; Edwin A M Gale; Barbara V Howard; M Sue Kirkman; Mikhail Kosiborod; Peter Reaven; Robert S Sherwin Journal: J Am Coll Cardiol Date: 2009-01-20 Impact factor: 24.094
Authors: William Duckworth; Carlos Abraira; Thomas Moritz; Domenic Reda; Nicholas Emanuele; Peter D Reaven; Franklin J Zieve; Jennifer Marks; Stephen N Davis; Rodney Hayward; Stuart R Warren; Steven Goldman; Madeline McCarren; Mary Ellen Vitek; William G Henderson; Grant D Huang Journal: N Engl J Med Date: 2008-12-17 Impact factor: 91.245
Authors: Hertzel C Gerstein; Michael E Miller; Robert P Byington; David C Goff; J Thomas Bigger; John B Buse; William C Cushman; Saul Genuth; Faramarz Ismail-Beigi; Richard H Grimm; Jeffrey L Probstfield; Denise G Simons-Morton; William T Friedewald Journal: N Engl J Med Date: 2008-06-06 Impact factor: 91.245
Authors: Matthew R Weir; Fawn Yeh; Angela Silverman; Richard B Devereux; James M Galloway; Jeffrey A Henderson; William J Howard; Marie Russell; Charlton Wilson; Robert Ratner; John Sorkin; Jason G Umans; Jerome L Fleg; Mario Stylianou; Elisa Lee; Barbara V Howard Journal: J Clin Hypertens (Greenwich) Date: 2009-10 Impact factor: 3.738
Authors: Marguerite J McNeely; Robyn L McClelland; Diane E Bild; David R Jacobs; Russell P Tracy; Mary Cushman; David C Goff; Brad C Astor; Steven Shea; David S Siscovick Journal: Diabetes Care Date: 2009-06-23 Impact factor: 19.112
Authors: Peter D Reaven; Thomas E Moritz; Dawn C Schwenke; Robert J Anderson; Michael Criqui; Robert Detrano; Nicholas Emanuele; Moti Kayshap; Jennifer Marks; Sunder Mudaliar; R Harsha Rao; Jayendra H Shah; Steven Goldman; Domenic J Reda; Madeline McCarren; Carlos Abraira; William Duckworth Journal: Diabetes Date: 2009-08-03 Impact factor: 9.461