title: Multiple risk factor intervention and progression of coronary atherosclerosis in patients with type 2 diabetes mellitus.
abstract: BACKGROUND
  Diabetic patients with coronary artery disease (CAD) demonstrate accelerated progression of coronary atherosclerosis. The impact of multiple risk factor intervention on disease progression has not been investigated.
  
  
  METHODS
  We investigated 448 diabetic patients with angiographic CAD who underwent serial intravascular ultrasound imaging to monitor the change in atheroma burden in seven clinical trials.
  
  
  METHODS
  Disease progression was compared in patients stratified according to whether they achieved increasing numbers of treatment goals of individual risk factors (HbA1c <7.0%, LDL cholesterol <2.5 mmol/l, triglyceride <1.7 mmol/l, systolic blood pressure <130 mmHg, high sensitivity C-reactive protein <2.0 mg/l).
  
  
  RESULTS
  A high rate of established medical therapies was used in all patients (89% statins, 94% aspirin, 76% β-blockers, 66% ACE inhibitors, 66% metformin, 62% thiazolidinediones, 17% insulin). No differences were observed with regard to percentage atheroma volume (PAV) and total atheroma volume (TAV) at baseline. On serial evaluation, slowing of progression of PAV (p = 0.01) and TAV (p < 0.001) was observed with increasing numbers of risk factors achieving treatment goals. On multivariate analysis adjusting for baseline risk factors, increasing the number of factors meeting treatment goals continued to be associated with a beneficial impact on progression of PAV (p = 0.03) and TAV (p < 0.001).
  
  
  CONCLUSIONS
  The benefit of achieving optimal control of multiple risk factors underscores the need for modification of global risk in patients with diabetes.
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Yu
authors.initials: Y
authors.lastname: Kataoka
authors.forename: Mingyuan
authors.initials: M
authors.lastname: Shao
authors.forename: Kathy
authors.initials: K
authors.lastname: Wolski
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Uno
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.forename: Steven E
authors.initials: SE
authors.lastname: Nissen
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000378:metabolism; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D008078:Cholesterol, LDL / Q000097:blood; D002986:Clinical Trials as Topic; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D016018:Least-Squares Analysis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D018084:Ultrasonography, Interventional
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D002317:Cardiovascular Agents; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D014280:Triglycerides; C517652:hemoglobin A1c protein, human