Issue 141 Item 7 Cardiovascular Risks In Diabetics Can Be Halved

Intense, long-term intervention for Type 2 diabetes cuts risk of cardiovascular (CV) and microvascular events by about half. This is the finding of multi-center study in Denmark led by Dr Peter Gaede from the Steno Diabetes Centre, Copenhagen.

Cardiovascular (CV) morbidity remains a major problem among patients with type two diabetes, especially those with microalbuminuria.

The investigators compared conventional with intensive therapy involving stepwise implementation of behaviour modification and pharmacologic therapy targeted at hyperglycemia, hypertension, dyslipidemia and microalbuminuria, along with secondary prevention of CV disease with aspirin.

Primary end point in the open, parallel (Steno-2) study, was a composite of death from CV causes, nonfatal myocardial infarction, nonfatal stroke, revascularisation and amputation.

Eighty patients were randomly assigned to receive conventional treatment (per national guidelines) and 80 to receive intensive treatment.

Mean age of the patients was 55.1 years, and mean follow-up was 7.8 years.

Decline in glycosylated hemoglobin values, systolic and diastolic blood pressure, serum cholesterol and triglyceride levels measured after an overnight fast, and urinary albumin excretion rate were all significantly greater in the intensive- than in the conventional-therapy group.

Patients on the intensive therapy also had a significantly lower risk of CV disease, nephropathy, retinopathy and autonomic neuropathy than did those on conventional therapy.
N Engl J Med 2003;348:383-393