Relationship of Glycemia to Cardiovascular Disease ... - Lipids Online

SANDS Randomized Trial: Effects of Lower LDL-Cholesterol and Blood-Pressure
Targets on C-IMT and Left Ventricular Mass in Diabetes
In the SANDS trial, Native Americans with type 2 diabetes underwent measurements of
carotid intima-media thickness (C-IMT) and left ventricular mass (LVM) at baseline, at
18 months, and again at 36 months. One group, called the “standard” group, had their
low-density lipoprotein (LDL) targeted to 100 mg/dL and their systolic blood pressure
(SBP) targeted to 130 mm Hg. The second group, called the “intensive” group, had
targets of 70 mg/dL and 115 mm Hg for LDL and SBP, respectively. Among the patients
randomized to the intensive targets, fewer patients had a progression of C-IMT, and
fewer patients had an increase in LVM. This study is interesting because it suggests that
lowering LDL and SBP to targets beyond that which are currently recommended for
these patients could yield additional cardiovascular benefit.
Reference:
Howard BV, Roman MJ, Devereux RB, et al. Effect of lower targets for blood pressure
and LDL cholesterol on atherosclerosis in diabetes: the SANDS randomized trial. JAMA.
2008;299:1678-1689.
BARI-2D:
Evaluating Treatment Options for
Patients With Type 2 Diabetes Mellitus and
Coronary Artery Disease
Inclusion Criteria
Type 2 DM
Stable CAD
Exclusion Criteria
Mandatory CABG
–Unstable CAD
–CAD extent
–Left ventricular
function
Insulin
Providing
Insulin
Sensitizing
2 x 2 Factorial Design (n = 2600)
Medical Rx
Medical Rx
CATH
Revascularization
of Choice
and
Medical Rx
Revascularization
of Choice
and
Medical Rx
CABG = coronary artery bypass graft; CAD = coronary artery disease; DM = diabetes mellitus
Brooks MM, et al. Am J Cardiol. 2006;97:9G-19G.
Slide Source
Lipids Online Slide Library
www.lipidsonline.org
BARI-2D: Evaluating Treatment Options for Patients With Type 2 Diabetes
Mellitus and Coronary Artery Disease
In the trial design of the BARI-2D study, patients with diabetes and stable coronary
artery disease are randomized to receive either an insulin-providing regimen with
sulfonylurea and insulin or an insulin-sensitizing regimen with metformin and
rosiglitazone. Patients are also randomized to revascularization of choice with either
percutaneous coronary intervention or coronary artery bypass graft surgery, depending on
the extent of coronary artery disease, or intensive medical treatment for angina. The
results of this study will be reported at meetings of the American Diabetes Association in
Source: Lipids Online Slide Library (www.lipidsonline.org) Page 35 of 36
© 2009 Baylor College of Medicine, Houston, Texas