title: Multiple risk factor intervention reduces carotid atherosclerosis in patients with type 2 diabetes.
abstract: BACKGROUND
  Patients with rapid progression of carotid intima media thickness (CIMT) were shown to have a higher future risk for cardiovascular events.The aim of this study was to investigate the impact of multiple risk factor intervention on CIMT progression and to establish whether new cardiovascular surrogate measurements would allow prediction of CIMT changes.
  
  
  METHODS
  In this prospective, open, 2-years study, we included 97 patients with type 2 diabetes and at least two insufficiently treated cardiovascular risk factors, i.e. HbA1c > 7.5% (58 mmol/mol); LDL-cholesterol >3.1 mmol/l or blood pressure >140/90 mmHg. Treatment was intensified according to current guidelines over 3 months with the aim to maintain intensification over 2 years.The primary outcome was the change in CIMT after 2 years. We also assessed markers of mechanical and biochemical endothelial function and endothelial progenitor cells before and after 3 months of treatment intensification. For testing differences between before and after multifactorial treatment measurements we used either the paired student's t-test or the Wilcoxon signed-rank test, depending on the distribution of the data. Additional, explorative statistical data analysis was done on CIMT progression building a linear multivariate regression model.
  
  
  RESULTS
  Blood glucose, lipids and blood pressure significantly improved during the first 3 months of intensified treatment, which was sustained over the 2-year study duration. Mean CIMT significantly decreased from baseline to 2 year (0.883 ± 0.120 mm vs. 0.860 ± 0.130 mm; p = 0.021). None of the investigated surrogate measures, however, was able to predict changes in IMT early after treatment intensification.
  
  
  CONCLUSIONS
  Intensification of risk factor intervention in type 2 diabetes results in CIMT regression over a period of 2 years. None of the biomarkers used including endothelial function parameters or endothelial progenitor cells turned out to be useful to predict CIMT changes.
  
  
  BACKGROUND
  Clinical Trial Registration - Unique identifier: NCT00660790.
authors.forename: Norbert J
authors.initials: NJ
authors.lastname: Tripolt
authors.forename: Sophie H
authors.initials: SH
authors.lastname: Narath
authors.forename: Michaela
authors.initials: M
authors.lastname: Eder
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Pieber
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Wascher
authors.affiliation: Department for Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria. ha.sourij@medunigraz.at.
authors.forename: Harald
authors.initials: H
authors.lastname: Sourij
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D059168:Carotid Intima-Media Thickness; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D002317:Cardiovascular Agents; D007004:Hypoglycemic Agents