title: Neutral impact on systolic and diastolic cardiac function of 2 years of intensified multi-intervention in type 2 diabetes: the randomized controlled Asker and Bærum Cardiovascular Diabetes (ABCD) study.
abstract: BACKGROUND
  Patients with type 2 diabetes (T2D) are prone to develop preclinical myocardial dysfunction, but no single strategy to prevent progression to heart failure has been established. We aimed to assess whether intensified global cardiovascular (CV) risk factor control would improve left ventricular (LV) systolic and diastolic function as compared with standard of care.
  
  
  METHODS
  A total of 100 patients with ≥1 CV risk factor (29% female, mean ± SD age 58 ± 10 years, LV ejection fraction 63 ± 8%, 16% with LV diastolic dysfunction) were randomized to 2 years of intensified CV risk multi-intervention (INT, n = 50) or standard care (STAND, n = 50). Echocardiography, including tissue Doppler imaging, and maximum exercise test were performed at baseline and study end. Multi-intervention comprised lifestyle intervention and pharmacologic treatment to reach strict prespecified CV risk factor goals, whereas STAND group received current guideline care.
  
  
  RESULTS
  Greater reductions were observed for hemoglobin A1c and total cholesterol in the INT group (P < .001 and P = .021, respectively), whereas blood pressure reduction was similar. Work capacity increased in INT and decreased in STAND (P = .014). There was no significant between-group difference in the change in any of the echocardiographic parameters.
  
  
  CONCLUSIONS
  Two years of intensified multi-intervention in patients with T2D improved work capacity and glycemic and lipid control and had no significant benefit or harm on resting cardiac function.
authors.affiliation: Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Norway. Electronic address: Annepernille@hotmail.com.
authors.forename: Anne Pernille
authors.initials: AP
authors.lastname: Ofstad
authors.affiliation: Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Norway.
authors.forename: Odd Erik
authors.initials: OE
authors.lastname: Johansen
authors.affiliation: Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway; K.G. Jebsen Cardiac Research Centre and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Gullestad
authors.affiliation: Department of Endocrinology, Morbid Obesity, and Preventive Medicine, Oslo University Hospital Aker, Oslo, Norway.
authors.forename: Kåre I
authors.initials: KI
authors.lastname: Birkeland
authors.affiliation: Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Norway.
authors.forename: Elsa
authors.initials: E
authors.lastname: Orvik
authors.affiliation: Unit of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Morten W
authors.initials: MW
authors.lastname: Fagerland
authors.affiliation: Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
authors.forename: Stig
authors.initials: S
authors.lastname: Urheim
authors.affiliation: Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
authors.forename: Svend
authors.initials: S
authors.lastname: Aakhus
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000517:prevention & control*; D003971:Diastole / Q000502:physiology; D018450:Disease Progression; D005080:Exercise Test; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology*