title: Examination of lower targets for low-density lipoprotein cholesterol and blood pressure in diabetes--the Stop Atherosclerosis in Native Diabetics Study (SANDS).
abstract: Diabetes incidence is increasing rapidly in the United States. Diabetes increases the risk for cardiovascular disease, the major cause of death in diabetic individuals. The conventional cardiovascular risk factors of hyperlipidemia and hypertension worsen diabetic vascular disease. Treatment targets for low-density lipoprotein cholesterol (LDL-C) and blood pressure in diabetic individuals are being debated. The SANDS is a randomized, open-label, 3-year trial to examine the effects of aggressive LDL-C (goal <70 mg/dL) and blood pressure (BP) (goal <115/75 mm Hg) reduction versus the standard goals of <100 mg/dL for LDL-C and <130/85 mm Hg for BP. Five hundred forty-nine American-Indian men and women >40 years old with type 2 diabetes were randomized to 1 of 2 groups. Lipids and BP are managed using Food and Drug Administration-approved medications in an algorithmic approach. The presence and progression of atherosclerosis are evaluated by carotid ultrasonography; echocardiography assesses cardiac function. The primary end point is the composite outcome of change in carotid artery intimal medial thickness and fatal/nonfatal cardiovascular events. These outcomes are combined by using a ranked analysis for carotid thickness and assigning a "worst rank" for a cardiovascular event. Secondary end points include carotid plaque score, left ventricular geometry and function, serum C-reactive protein, and safety measures. Unique aspects of the study design and analysis plan involve the use of a composite outcome and changes during the trial of LDL-C treatment goals for participants with baseline or incident cardiovascular disease in the conventional group because of changes in the standard of care. Study results will further understanding of the effects of aggressive risk factor reduction on atherosclerosis burden and cardiac function in diabetic individuals in US populations and will help determine optimal LDL-C and BP treatment goals for diabetic patients.
authors.affiliation: Phoenix Indian Medical Center, Phoenix, AZ, USA.
authors.forename: Marie
authors.initials: M
authors.lastname: Russell
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Fleg
authors.forename: Wm James
authors.initials: WJ
authors.lastname: Galloway
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Henderson
authors.forename: James
authors.initials: J
authors.lastname: Howard
authors.forename: Elisa T
authors.initials: ET
authors.lastname: Lee
authors.forename: Bryce
authors.initials: B
authors.lastname: Poolaw
authors.forename: Robert E
authors.initials: RE
authors.lastname: Ratner
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Roman
authors.forename: Angela
authors.initials: A
authors.lastname: Silverman
authors.forename: Mario
authors.initials: M
authors.lastname: Stylianou
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
authors.forename: Charlton
authors.initials: C
authors.lastname: Wilson
authors.forename: Fawn
authors.initials: F
authors.lastname: Yeh
authors.forename: Jianhui
authors.initials: J
authors.lastname: Zhu
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
mesh_terms: D000328:Adult; D000465:Algorithms; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D018450:Disease Progression; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D012107:Research Design; D014463:Ultrasonography
chemical_list: D008078:Cholesterol, LDL