237-OR: Beneficial Impact of Intensified Multifactorial Intervention on Stroke—The Steno-2 Study

Abstract

Epidemiological studies have shown that diabetes is a well-established independent but modifiable risk factor for stroke. In the Steno-2 Study 160 patients with T2DM and microalbuminuria were randomised to intensified or conventional multiple risk factor intervention targeting classical CVD risk factors for a mean of 7.8 years and then followed for up to 21.9 years. The primary endpoint in this post hoc analysis was time to first stroke (Cox regression adjusted for age and sex). Baseline predictors were examined using backwards regression elimination (threshold of α = 0.10) of the following variables: age, sex, known diabetes duration, smoking status, left ventricular ejection fraction, heart rate variability, atrial fibrillation, BMI, systolic BP, GFR, retinopathy, HbA1c, proBNP and total cholesterol, and urinary albumin excretion rate. During follow-up 30 participants experienced a total of 39 strokes. More patients randomised to conventional therapy experienced a stroke with 21 participants (26%) with 29 strokes in the conventional-therapy group vs. 9 participants (11%) with a total of 10 strokes in the intensive therapy group. Baseline systolic BP and GFR were significant risk factors for stroke. In conclusion, intensified multiple risk factor intervention in patients with type 2 diabetes and microalbuminuria reduces the risk for strokes as well as the number of recurrent cerebrovascular events. Disclosure P. Gæde: None. J. Oellgaard: Employee; Self; Novo Nordisk A/S. C. Kruuse: Speaker's Bureau; Self; Novo Nordisk A/S. P. Rossing: Advisory Panel; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Eli Lilly and Company, Merck Sharp & Dohme Corp. Other Relationship; Self; Novartis AG, Novo Nordisk A/S. H.D. Parving: None. O. Pedersen: None.