Issue 160 Item 6 ADA: Lifestyle Modification May Cut Cardiovascular Disease Risk

Simple lifestyle modifications may prevent the development of cardiovascular disease in patients with impaired glucose tolerance.

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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