Aramesh Saremi1, Dawn C Schwenke2, Gideon Bahn3, Ling Ge3, Nicholas Emanuele4, Peter D Reaven5. 1. Phoenix VA Health Care System, Phoenix, Arizona. Electronic address: Aramesh.Saremi@va.gov. 2. Phoenix VA Health Care System, Phoenix, Arizona. 3. Cooperative Studies Program Coordinating Center, Hines, Illinois. 4. Medical and Research Services, Hines Veterans Affairs Hospital, Hines, Illinois. 5. Phoenix VA Health Care System, Phoenix, Arizona. Electronic address: Peter.Reaven@Va.gov.
Abstract
OBJECTIVE: To examine the effect of intensive glycemic control on cardiovascular disease events (CVD) among the major race/ethnic groups in a post-hoc analysis of the VADT. MATERIALS AND METHODS:Participants included 1111 non-Hispanic Whites, 307 Hispanics and 306 non-Hispanic Blacks randomized tointensive or standard glucose treatment in VADT. Multivariable Cox proportional hazards models were constructed to assess the effect of intensive glucose treatment on CVD events among race/ethnic groups. RESULTS:Mean age was 60.4 years and median follow-up was 5.6 years. By design, modifiable risk factors were managed equally well in both treatment arms and only differed modestly between race/ethnic groups. HbA(1c) decreased significantly from baseline with intensive glucose treatment in each race/ethnic group, with a trend for a greater response in Hispanics (P=0.02 for overall comparison between groups). Intensive glucose treatment was associated with reduced risk of CVD events for Hispanics but not for others (hazard ratios ranged from 0.54 to 0.75 for Hispanics whereas they were consistently close to 1 for others). Sensitivity analyses with different definitions of race/ethnicity or limited to individuals free of previous known CVD yielded similar results. CONCLUSIONS: The results of these analyses support the hypothesis that race/ethnicity is worthy of consideration when tailoring intensive treatment for individuals with long-standing type 2 diabetes. However, additional studies are needed to confirm the findings of this post-hoc analysis. Published by Elsevier Inc.
RCT Entities:
OBJECTIVE: To examine the effect of intensive glycemic control on cardiovascular disease events (CVD) among the major race/ethnic groups in a post-hoc analysis of the VADT. MATERIALS AND METHODS:Participants included 1111 non-Hispanic Whites, 307 Hispanics and 306 non-Hispanic Blacks randomized to intensive or standard glucose treatment in VADT. Multivariable Cox proportional hazards models were constructed to assess the effect of intensive glucose treatment on CVD events among race/ethnic groups. RESULTS: Mean age was 60.4 years and median follow-up was 5.6 years. By design, modifiable risk factors were managed equally well in both treatment arms and only differed modestly between race/ethnic groups. HbA(1c) decreased significantly from baseline with intensive glucose treatment in each race/ethnic group, with a trend for a greater response in Hispanics (P=0.02 for overall comparison between groups). Intensive glucose treatment was associated with reduced risk of CVD events for Hispanics but not for others (hazard ratios ranged from 0.54 to 0.75 for Hispanics whereas they were consistently close to 1 for others). Sensitivity analyses with different definitions of race/ethnicity or limited to individuals free of previous known CVD yielded similar results. CONCLUSIONS: The results of these analyses support the hypothesis that race/ethnicity is worthy of consideration when tailoring intensive treatment for individuals with long-standing type 2 diabetes. However, additional studies are needed to confirm the findings of this post-hoc analysis. Published by Elsevier Inc.
Entities:
Keywords:
CVD; Ethnicity; Intensive glycemic control; Race; Type 2 diabetes
Authors: Peter D Reaven; Dewayne Thurmond; Alisa Domb; Richard Gerkin; Matthew J Budoff; Steven Goldman Journal: Am J Cardiol Date: 2003-11-15 Impact factor: 2.778
Authors: Hertzel C Gerstein; Michael E Miller; Saul Genuth; Faramarz Ismail-Beigi; John B Buse; David C Goff; Jeffrey L Probstfield; William C Cushman; Henry N Ginsberg; J Thomas Bigger; Richard H Grimm; Robert P Byington; Yves D Rosenberg; William T Friedewald Journal: N Engl J Med Date: 2011-03-03 Impact factor: 91.245
Authors: Rena R Wing; Paula Bolin; Frederick L Brancati; George A Bray; Jeanne M Clark; Mace Coday; Richard S Crow; Jeffrey M Curtis; Caitlin M Egan; Mark A Espeland; Mary Evans; John P Foreyt; Siran Ghazarian; Edward W Gregg; Barbara Harrison; Helen P Hazuda; James O Hill; Edward S Horton; Van S Hubbard; John M Jakicic; Robert W Jeffery; Karen C Johnson; Steven E Kahn; Abbas E Kitabchi; William C Knowler; Cora E Lewis; Barbara J Maschak-Carey; Maria G Montez; Anne Murillo; David M Nathan; Jennifer Patricio; Anne Peters; Xavier Pi-Sunyer; Henry Pownall; David Reboussin; Judith G Regensteiner; Amy D Rickman; Donna H Ryan; Monika Safford; Thomas A Wadden; Lynne E Wagenknecht; Delia S West; David F Williamson; Susan Z Yanovski Journal: N Engl J Med Date: 2013-06-24 Impact factor: 91.245
Authors: Christina L Wassel; James S Pankow; Laura J Rasmussen-Torvik; Na Li; Kent D Taylor; Xiuqing Guo; Mark O Goodarzi; Walter R Palmas; Wendy S Post Journal: Obesity (Silver Spring) Date: 2010-10-07 Impact factor: 5.002
Authors: Kelly J Hunt; Ken Williams; Roy G Resendez; Helen P Hazuda; Steve M Haffner; Michael P Stern Journal: Diabetes Care Date: 2002-09 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
Authors: Leah E Cahill; Majken K Jensen; Stephanie E Chiuve; Hadar Shalom; Jennifer K Pai; Alan J Flint; Kenneth J Mukamal; Kathryn M Rexrode; Andrew P Levy; Eric B Rimm Journal: J Am Coll Cardiol Date: 2015-10-20 Impact factor: 24.094
Authors: Marinella Ruospo; Valeria M Saglimbene; Suetonia C Palmer; Salvatore De Cosmo; Antonio Pacilli; Olga Lamacchia; Mauro Cignarelli; Paola Fioretto; Mariacristina Vecchio; Jonathan C Craig; Giovanni Fm Strippoli Journal: Cochrane Database Syst Rev Date: 2017-06-08
Authors: Poojitha Rajasekar; Christina L O'Neill; Lydia Eeles; Alan W Stitt; Reinhold J Medina Journal: J Diabetes Res Date: 2015-05-28 Impact factor: 4.011