title: The effect of age on clinical outcomes and health status BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes).
abstract: OBJECTIVE
  The purpose of this study was to determine the extent to which effectiveness of cardiac and diabetes treatment strategies varies by patient age.
  
  
  BACKGROUND
  The impact of age on the effectiveness of revascularization and hyperglycemia treatments has not been thoroughly investigated.
  
  
  METHODS
  In the BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes) trial, 2,368 patients with documented stable heart disease and type 2 diabetes were randomized to receive prompt revascularization versus initial medical therapy with deferred revascularization and insulin sensitization versus insulin provision for hyperglycemia treatment. Patients were followed for an average of 5.3 years. Cox regression and mixed models were used to investigate the effect of age and randomized treatment assignment on clinical and health status outcomes.
  
  
  RESULTS
  The effect of prompt revascularization versus medical therapy did not differ by age for death (interaction p = 0.99), major cardiovascular events (interaction p = 0.081), angina (interaction p = 0.98), or health status outcomes. After intervention, participants of all ages had significant angina and health status improvement. Younger participants experienced a smaller decline in health status during follow-up than older participants (age by time interaction p < 0.01). The effect of the randomized glycemia treatment on clinical and health status outcomes was similar for patients of different ages.
  
  
  CONCLUSIONS
  Among patients with stable heart disease and type 2 diabetes, the relative beneficial effects of a strategy of prompt revascularization versus initial medical therapy and insulin-sensitizing versus insulin-providing therapy on clinical endpoints, symptom relief, and perceived health status outcomes do not vary by age. Health status improved significantly after treatment for all ages, and this improvement was sustained longer among younger patients. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes [BARI 2D]; NCT00006305).
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania, USA. mbrooks@pitt.edu
authors.forename: Sheng-Chia
authors.initials: SC
authors.lastname: Chung
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hlatky
authors.forename: David
authors.initials: D
authors.lastname: Faxon
authors.forename: Kodangudi
authors.initials: K
authors.lastname: Ramanathan
authors.forename: Dale
authors.initials: D
authors.lastname: Adler
authors.forename: Arshag
authors.initials: A
authors.lastname: Mooradian
authors.forename: Charanjit
authors.initials: C
authors.lastname: Rihal
authors.forename: Roslyn A
authors.initials: RA
authors.lastname: Stone
authors.forename: Joyce T
authors.initials: JT
authors.lastname: Bromberger
authors.forename: Sheryl F
authors.initials: SF
authors.lastname: Kelsey
authors.forename: Maria Mori
authors.initials: MM
authors.lastname: Brooks
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000453:epidemiology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006304:Health Status; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin