title: Race/ethnic disparities in risk factor control and survival in the bypass angioplasty revascularization investigation 2 diabetes (BARI 2D) trial.
abstract: This study sought to evaluate the impact of race/ethnicity on cardiovascular risk factor control and on clinical outcomes in a setting of comparable access to medical care. The BARI 2D trial enrolled 1,750 participants from the United States and Canada that self-reported either White non-Hispanic (n = 1,189), Black non-Hispanic (n = 349), or Hispanic (n = 212) race/ethnicity. Participants had type 2 diabetes and coronary artery disease and were randomized to cardiac and glycemic treatment strategies. All patients received intensive target-based medical treatment for cardiac risk factors. Average follow-up was 5.3 years. Kaplan-Meier survival curves and Cox proportional hazards regression models were constructed to assess potential differences in mortality and cardiovascular outcomes across racial/ethnic groups. Long-term risk of death and death/myocardial infarction/stroke did not vary significantly by race/ethnicity (5-year death: 11.0% Whites, 13.7% Blacks, 8.7% Hispanics, p = 0.19; adjusted hazard ratio 1.18 Black versus White, 95% confidence interval 0.84 to 1.67, p = 0.33 and 0.82 Hispanic versus White, 95% confidence interval 0.51 to 1.34, p = 0.43). Among the 1,168 patients with suboptimal risk factor control at baseline, the ability to attain better risk factor control during the trial was associated with higher 5-year survival (71%, 86% and 95% for patients with 0 or 1, 2, and 3 factors in control, respectively, p <0.001); this pattern was observed within each race/ethnic group. In conclusion, significant race/ethnic differences in cardiac risk profiles that persisted during follow-up did not translate into significant differences in 5-year death or death/MI/stroke.
authors.affiliation: Division of Cardiology, Columbia University, Mount Sinai Medical Center, Miami Beach, Florida.
authors.forename: Nirat
authors.initials: N
authors.lastname: Beohar
authors.forename: Veronica V
authors.initials: VV
authors.lastname: Sansing
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Davis
authors.forename: V S
authors.initials: VS
authors.lastname: Srinivas
authors.forename: Tarek
authors.initials: T
authors.lastname: Helmy
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Althouse
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Thomas
authors.forename: Maria Mori
authors.initials: MM
authors.lastname: Brooks
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000208:ethnology* / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000208:ethnology*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors
references.citation: Am J Cardiol. 2006 Jun 19;97(12A):41G-52G
references.pmid: 16813737
references.citation: Diabetes Care. 2004 Dec;27(12):2980-2
references.pmid: 15562219
references.citation: N Engl J Med. 2009 Jun 11;360(24):2503-15
references.pmid: 19502645
references.citation: Circulation. 2012 Jul 3;126(1):8-10
references.pmid: 22693352
references.citation: Circulation. 2010 Sep 14;122(11):1085-90
references.pmid: 20805432
references.citation: Am J Cardiol. 2003 Oct 1;92(7):773-8
references.pmid: 14516874
references.citation: JAMA. 1993 May 26;269(20):2642-6
references.pmid: 8487447
references.citation: Arch Intern Med. 2008 Jun 9;168(11):1145-51
references.pmid: 18541821
references.citation: Diabetes Care. 2009 Dec;32(12):2212-7
references.pmid: 19755626
references.citation: Diabetes Care. 2006 Aug;29(8):1924-5
references.pmid: 16873805
references.citation: J Invasive Cardiol. 2010 Apr;22(4):168-73
references.pmid: 20351387
references.citation: Circulation. 2010 Jun 1;121(21):2294-301
references.pmid: 20479153
references.citation: Med Care Res Rev. 2007 Oct;64(5 Suppl):101S-56S
references.pmid: 17881626
references.citation: Arch Intern Med. 2000 May 8;160(9):1329-35
references.pmid: 10809037
references.citation: N Engl J Med. 1997 Feb 13;336(7):480-6
references.pmid: 9017942
references.citation: Med Care. 1999 Jan;37(1):68-77
references.pmid: 10413394
references.citation: Med Care Res Rev. 2007 Oct;64(5 Suppl):29S-100S
references.pmid: 17881625
references.citation: Am Heart J. 2011 Apr;161(4):755-63
references.pmid: 21473976
references.citation: Circ Cardiovasc Qual Outcomes. 2010 Sep;3(5):484-9
references.pmid: 20807884
references.citation: Circulation. 2008 Mar 18;117(11):1355-7
references.pmid: 18347219
references.citation: Am J Cardiol. 2006 Jun 19;97(12A):9G-19G
references.pmid: 16813734