Risk Factor Control for Coronary Artery Disease Secondary Prevention in Large Randomized Trials
Identifieur interne : 000400 ( Canada/Analysis ); précédent : 000399; suivant : 000401Risk Factor Control for Coronary Artery Disease Secondary Prevention in Large Randomized Trials
Auteurs : Michael E. Farkouh [États-Unis, Canada] ; William E. Boden [États-Unis] ; Vera Bittner [États-Unis] ; Victoria Muratov [États-Unis] ; Pamela Hartigan [États-Unis] ; May Ogdie [États-Unis] ; Marnie Bertolet [États-Unis] ; Shiny Mathewkutty [États-Unis] ; Koon Teo [Canada] ; David J. Maron [États-Unis] ; Sanjum S. Sethi [États-Unis] ; Michael Domanski [États-Unis] ; Robert L. Frye [États-Unis] ; Valentin Fuster [États-Unis, Espagne]Source :
- Journal of the American College of Cardiology [ 0735-1097 ] ; 2013.
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Abstract
Objectives This study evaluated data from 3 federally funded trials that focused on optimal medical therapy to determine if formalized attempts at risk factor control within clinical trials are effective in achieving guideline-driven treatment goals for diabetic patients with coronary artery disease (CAD). Background Despite clear evidence of benefit for CAD secondary prevention, the level of risk factor control in clinical practice has been disappointing. Methods We obtained data from the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) diabetes subgroup, (n = 766 of 2,287), the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial (n = 2,368), and the FREEDOM (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes) trial (n = 1,900) to evaluate the proportion of patients achieving guideline-based, protocol-driven treatment targets for systolic blood pressure, low-density lipoprotein cholesterol, smoking cessation, and hemoglobin A1c. The primary outcome measure was the proportion of diabetic CAD patients meeting all 4 pre-specified targets at 1 year after enrollment. Results The pooled data include 5,034 diabetic patients. The percentages of patients achieving the 1-year low-density lipoprotein cholesterol targets compared with baseline increased from 55% to 77% in COURAGE, from 59% to 75% in BARI 2D, and from 34% to 42% in FREEDOM. Although similar improved trends were seen for systolic blood pressure, glycemic control, and smoking cessation, only 18% of the COURAGE diabetes subgroup, 23% of BARI 2D patients, and 8% of FREEDOM patients met all 4 pre-specified treatment targets at 1 year of follow-up. Conclusions A significant proportion of diabetic CAD patients fail to achieve pre-specified targets for 4 major modifiable cardiovascular risk factors in clinical trials. We conclude that fundamentally new thinking is needed to explore approaches to achieve optimal secondary prevention treatment goals.
Affiliations:
- Canada, Espagne, États-Unis
- Alabama, Communauté de Madrid, Connecticut, Massachusetts, Minnesota, Ontario, Pennsylvanie, Tennessee, État de New York
- Madrid, Pittsburgh, Toronto
- Université de Pittsburgh, Université de Toronto
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Farkouh</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Mount Sinai School of Medicine</s1><s2>New York, New York</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre of Excellence, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Boden, William E" sort="Boden, William E" uniqKey="Boden W" first="William E." last="Boden">William E. Boden</name><affiliation wicri:level="2"><inist:fA14 i1="03"><s1>Samuel S. Stratton VA Medical Center</s1><s2>Albany, New York</s2><s3>USA</s3><sZ>2 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Bittner, Vera" sort="Bittner, Vera" uniqKey="Bittner V" first="Vera" last="Bittner">Vera Bittner</name><affiliation wicri:level="2"><inist:fA14 i1="04"><s1>University of Alabama at Birmingham</s1><s2>Birmingham, Alabama</s2><s3>USA</s3><sZ>3 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Alabama</region></placeName></affiliation></author><author><name sortKey="Muratov, Victoria" sort="Muratov, Victoria" uniqKey="Muratov V" first="Victoria" last="Muratov">Victoria Muratov</name><affiliation wicri:level="2"><inist:fA14 i1="05"><s1>New England Research Institutes, Inc.</s1><s2>Watertown, Massachusetts</s2><s3>USA</s3><sZ>4 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Hartigan, Pamela" sort="Hartigan, Pamela" uniqKey="Hartigan P" first="Pamela" last="Hartigan">Pamela Hartigan</name><affiliation wicri:level="2"><inist:fA14 i1="06"><s1>VA Connecticut Healthcare System</s1><s2>West Haven, Connecticut</s2><s3>USA</s3><sZ>5 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Connecticut</region></placeName></affiliation></author><author><name sortKey="Ogdie, May" sort="Ogdie, May" uniqKey="Ogdie M" first="May" last="Ogdie">May Ogdie</name><affiliation wicri:level="2"><inist:fA14 i1="05"><s1>New England Research Institutes, Inc.</s1><s2>Watertown, Massachusetts</s2><s3>USA</s3><sZ>4 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Bertolet, Marnie" sort="Bertolet, Marnie" uniqKey="Bertolet M" first="Marnie" last="Bertolet">Marnie Bertolet</name><affiliation wicri:level="4"><inist:fA14 i1="07"><s1>University of Pittsburgh</s1><s2>Pittsburgh, Pennsylvania</s2><s3>USA</s3><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Pennsylvanie</region><settlement type="city">Pittsburgh</settlement></placeName><orgName type="university">Université de Pittsburgh</orgName></affiliation></author><author><name sortKey="Mathewkutty, Shiny" sort="Mathewkutty, Shiny" uniqKey="Mathewkutty S" first="Shiny" last="Mathewkutty">Shiny Mathewkutty</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Mount Sinai School of Medicine</s1><s2>New York, New York</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Teo, Koon" sort="Teo, Koon" uniqKey="Teo K" first="Koon" last="Teo">Koon Teo</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>McMaster University Medical Centre, Hamilton</s1><s2>Ontario, Ontario</s2><s3>CAN</s3><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Ontario, Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Maron, David J" sort="Maron, David J" uniqKey="Maron D" first="David J." last="Maron">David J. Maron</name><affiliation wicri:level="2"><inist:fA14 i1="09"><s1>Vanderbilt University Medical Center</s1><s2>Nashville, Tennessee</s2><s3>USA</s3><sZ>10 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Tennessee</region></placeName></affiliation></author><author><name sortKey="Sethi, Sanjum S" sort="Sethi, Sanjum S" uniqKey="Sethi S" first="Sanjum S." last="Sethi">Sanjum S. Sethi</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Mount Sinai School of Medicine</s1><s2>New York, New York</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Domanski, Michael" sort="Domanski, Michael" uniqKey="Domanski M" first="Michael" last="Domanski">Michael Domanski</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Mount Sinai School of Medicine</s1><s2>New York, New York</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Frye, Robert L" sort="Frye, Robert L" uniqKey="Frye R" first="Robert L." last="Frye">Robert L. Frye</name><affiliation wicri:level="2"><inist:fA14 i1="10"><s1>Mayo Clinic</s1><s2>Rochester, Minnesota</s2><s3>USA</s3><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Minnesota</region></placeName></affiliation></author><author><name sortKey="Fuster, Valentin" sort="Fuster, Valentin" uniqKey="Fuster V" first="Valentin" last="Fuster">Valentin Fuster</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Mount Sinai School of Medicine</s1><s2>New York, New York</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="11"><s1>Centro Nacional de Investigaciones Cardiovasculares (CNIC)</s1><s2>Madrid</s2><s3>ESP</s3><sZ>14 aut.</sZ></inist:fA14><country>Espagne</country><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Journal of the American College of Cardiology</title><title level="j" type="abbreviated">J. Am. Coll. Cardiol.</title><idno type="ISSN">0735-1097</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of the American College of Cardiology</title><title level="j" type="abbreviated">J. Am. Coll. Cardiol.</title><idno type="ISSN">0735-1097</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Cardiology</term><term>Cardiovascular disease</term><term>Check</term><term>Circulatory system</term><term>Clinical trial</term><term>Control</term><term>Coronary heart disease</term><term>Randomization</term><term>Regulation(control)</term><term>Risk factor</term><term>Surveillance</term><term>Treatment</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Cardiopathie coronaire</term><term>Pathologie de l'appareil circulatoire</term><term>Facteur risque</term><term>Commande</term><term>Contrôle</term><term>Régulation</term><term>Surveillance</term><term>Traitement</term><term>Essai clinique</term><term>Randomisation</term><term>Appareil circulatoire</term><term>Cardiologie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objectives This study evaluated data from 3 federally funded trials that focused on optimal medical therapy to determine if formalized attempts at risk factor control within clinical trials are effective in achieving guideline-driven treatment goals for diabetic patients with coronary artery disease (CAD). Background Despite clear evidence of benefit for CAD secondary prevention, the level of risk factor control in clinical practice has been disappointing. Methods We obtained data from the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) diabetes subgroup, (n = 766 of 2,287), the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial (n = 2,368), and the FREEDOM (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes) trial (n = 1,900) to evaluate the proportion of patients achieving guideline-based, protocol-driven treatment targets for systolic blood pressure, low-density lipoprotein cholesterol, smoking cessation, and hemoglobin A1c. The primary outcome measure was the proportion of diabetic CAD patients meeting all 4 pre-specified targets at 1 year after enrollment. Results The pooled data include 5,034 diabetic patients. The percentages of patients achieving the 1-year low-density lipoprotein cholesterol targets compared with baseline increased from 55% to 77% in COURAGE, from 59% to 75% in BARI 2D, and from 34% to 42% in FREEDOM. Although similar improved trends were seen for systolic blood pressure, glycemic control, and smoking cessation, only 18% of the COURAGE diabetes subgroup, 23% of BARI 2D patients, and 8% of FREEDOM patients met all 4 pre-specified treatment targets at 1 year of follow-up. Conclusions A significant proportion of diabetic CAD patients fail to achieve pre-specified targets for 4 major modifiable cardiovascular risk factors in clinical trials. We conclude that fundamentally new thinking is needed to explore approaches to achieve optimal secondary prevention treatment goals.</div></front></TEI><affiliations><list><country><li>Canada</li><li>Espagne</li><li>États-Unis</li></country><region><li>Alabama</li><li>Communauté de Madrid</li><li>Connecticut</li><li>Massachusetts</li><li>Minnesota</li><li>Ontario</li><li>Pennsylvanie</li><li>Tennessee</li><li>État de New York</li></region><settlement><li>Madrid</li><li>Pittsburgh</li><li>Toronto</li></settlement><orgName><li>Université de Pittsburgh</li><li>Université de Toronto</li></orgName></list><tree><country name="États-Unis"><region name="État de New York"><name sortKey="Farkouh, Michael E" sort="Farkouh, Michael E" uniqKey="Farkouh M" first="Michael E." last="Farkouh">Michael E. Farkouh</name></region><name sortKey="Bertolet, Marnie" sort="Bertolet, Marnie" uniqKey="Bertolet M" first="Marnie" last="Bertolet">Marnie Bertolet</name><name sortKey="Bittner, Vera" sort="Bittner, Vera" uniqKey="Bittner V" first="Vera" last="Bittner">Vera Bittner</name><name sortKey="Boden, William E" sort="Boden, William E" uniqKey="Boden W" first="William E." last="Boden">William E. Boden</name><name sortKey="Domanski, Michael" sort="Domanski, Michael" uniqKey="Domanski M" first="Michael" last="Domanski">Michael Domanski</name><name sortKey="Frye, Robert L" sort="Frye, Robert L" uniqKey="Frye R" first="Robert L." last="Frye">Robert L. Frye</name><name sortKey="Fuster, Valentin" sort="Fuster, Valentin" uniqKey="Fuster V" first="Valentin" last="Fuster">Valentin Fuster</name><name sortKey="Hartigan, Pamela" sort="Hartigan, Pamela" uniqKey="Hartigan P" first="Pamela" last="Hartigan">Pamela Hartigan</name><name sortKey="Maron, David J" sort="Maron, David J" uniqKey="Maron D" first="David J." last="Maron">David J. Maron</name><name sortKey="Mathewkutty, Shiny" sort="Mathewkutty, Shiny" uniqKey="Mathewkutty S" first="Shiny" last="Mathewkutty">Shiny Mathewkutty</name><name sortKey="Muratov, Victoria" sort="Muratov, Victoria" uniqKey="Muratov V" first="Victoria" last="Muratov">Victoria Muratov</name><name sortKey="Ogdie, May" sort="Ogdie, May" uniqKey="Ogdie M" first="May" last="Ogdie">May Ogdie</name><name sortKey="Sethi, Sanjum S" sort="Sethi, Sanjum S" uniqKey="Sethi S" first="Sanjum S." last="Sethi">Sanjum S. Sethi</name></country><country name="Canada"><region name="Ontario"><name sortKey="Farkouh, Michael E" sort="Farkouh, Michael E" uniqKey="Farkouh M" first="Michael E." last="Farkouh">Michael E. Farkouh</name></region><name sortKey="Teo, Koon" sort="Teo, Koon" uniqKey="Teo K" first="Koon" last="Teo">Koon Teo</name></country><country name="Espagne"><region name="Communauté de Madrid"><name sortKey="Fuster, Valentin" sort="Fuster, Valentin" uniqKey="Fuster V" first="Valentin" last="Fuster">Valentin Fuster</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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