ADA: Lifestyle Modification May
Cut Cardiovascular Disease Risk In Pre-Diabetics
Simple lifestyle modifications may prevent
the development of cardiovascular disease in patients
with impaired glucose tolerance.
That, from a follow-up analysis of data from
the Diabetes Prevention Program (DPP) suggests.
Use of metformin may also help prevent heart
disease in pre-diabetic patients, although to
a lesser degree, the analysis suggested.
Steven M. Haffner, MD, a professor of medicine
at the University of Texas Health Science Center
at San Antonio in the United States, reported
the findings at the American Diabetes Association
63rd Scientific Sessions. The analysis is a follow-up
to the landmark DPP trial of 3,234 overweight
people with pre-diabetes randomized to intensive
lifestyle intervention, 850 mg of metformin twice
a day, or placebo. Both the metformin and placebo
groups also received information on diet and exercise,
but no counseling efforts.
Those results, reported last year, showed that
at 3 years, participants who modified their lifestyles
reduced their risk of developing type 2 diabetes
by 58%, compared with those taking placebo. The
use of metformin reduced risk by 31%, compared
with those on placebo, the trial showed.
For the new analysis, the researchers looked
at 3 markers of cardiovascular disease risk --
levels of C-reactive protein (CRP), tissue plasminogen
activator (TPA) and fibrinogen -- that can be
affected by pharmacological or lifestyle interventions,
Dr. Haffner said.
From baseline to 1 year, CRP levels in men decreased
28% in the lifestyle intervention group, compared
with 5% in the metformin arm and 3% in the placebo
group, the study showed. In women, CRP levels
dropped 23% in the lifestyle arm, 12% in the metformin
arm and 1% in the placebo group.
TPA levels, which averaged around 11 mg/dL in
both genders in all 3 arms at baseline, decreased
18.9, 15.5 and 3.0% in the lifestyle, metformin
and placebo, arms, respectively.
Fibrinogen levels, which averaged 380 ng/dl to
386 ng/dl in the 3 arms at baseline, decreased
by 1.9 and 1.0% in the lifestyle and metformin
arms, respectively, while increasing by 2.4% in
the placebo group.
For all three measures, lifestyle intervention
was associated with a more significant drop in
values than metformin (p<0.05), Dr. Haffner
said.
The patients will continue to be followed to
see if the improvement in markers of heart disease
translate into actual clinical benefit, he said.
[Study title: The Effects of Intensive Lifestyle
Intervention (ILS) and Metformin (MET) on C-Reactive
Protein (CRP), Tissue Plasminogen Activator (TPA)
and Fibrinogen (FIB) in the Diabetes Prevention
Program (DPP). Abstract 79-OR]
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