BARI 2D Research Articles

Sex, Clinical Symptoms, and Angiographic Findings in Patients With Diabetes Mellitus and Coronary Artery Disease (from the Bypass Angioplasty Revascularization Investigation [BARI] 2 Diabetes Trial)

Previous studies have reported differences in presenting symptoms and angiographic characteristics between women and men undergoing evaluation for suspected coronary artery disease (CAD). We examined the relation between symptoms and extent of CAD in patients with type 2 diabetes mellitus and known CAD enrolled in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. Of 1,775 patients (533 women, 30%, and 1,242 men, 70%), women were more likely than men to have angina (65% vs 56%, p <0.001) or an atypical angina/anginal equivalent (71% vs 58%, p <0.001). More women reported unstable angina (17% vs 13%, p = 0.047) or were in a higher Canadian Cardiology Society class compared to men (Canadian Cardiology Society classes II to IV 78% vs 68%, p = 0.002). Fewer women than men had no symptoms (14% vs 22%, p <0.001). Women had a lower mean myocardial jeopardy index (42.5 ± 24.3 vs 47.9 ± 24.3, p <0.001), smaller number of total significant lesions (2.3 ± 1.7 vs 2.7 ± 1.8, p <0.001), and fewer jeopardized left ventricular regions (p <0.001 for distribution) or long-term occlusions (29% vs 42%, p <0.001). After adjustment for relevant covariates, the odds of having CAD symptoms were still higher in women than men (odds ratio for angina 1.31, 95% confidence interval 1.02 to 1.69; odds ratio for atypical angina 1.52, 95% confidence interval 1.17 to 1.96). In conclusion, in a high-risk group of patients with known CAD and diabetes mellitus, women were more symptomatic than men but had less obstructive CAD. These data suggest that factors other than epicardial CAD severity influence symptom presentation in women in this population.

The Prevalence and Predictors of an Abnormal Ankle-Brachial Index in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial

OBJECTIVETo examine ankle-brachial index (ABI) abnormalities in patients with type 2 diabetes and coronary artery disease (CAD).RESEARCH DESIGN AND METHODSAn ABI was obtained in 2,240 patients in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial. ABIs were classified as: normal, 0.91–1.3; low, ≤0.9; high, >1.3; or noncompressible artery (NC). Baseline characteristics were examined according to ABI and by multivariate analysis.RESULTSABI was normal in 66%, low in 19%, and high in 8% of patients, and 6% of patients had NC. Of the low ABI patients, 68% were asymptomatic. Using normal ABI as referent, low ABI was independently associated with smoking, female sex, black race, hypertension, age, C-reactive protein, diabetes duration, and lower BMI. High ABI was associated with male sex, nonblack race, and higher BMI; and NC artery was associated with diabetes duration, higher BMI, and hypertension.CONCLUSIONSABI abnormalities are common and often asymptomatic in patients with type 2 diabetes and CAD.

Editorials Editorial on management of diabetes mellitus with coronary artery disease

Editorials Editorial on management of diabetes mellitus with coronary artery disease

Clinical implications of the BARI 2D and COURAGE trials of coronary artery disease

The results of the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) and Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) clinical trials raise important questions about the prevention and treatment of coronary heart disease among type 2 diabetics and nondiabetics. The BARI 2D and COURAGE trials showed that pharmacological therapy is as effective as surgery or angioplasty, because of the incidence of total mortality and cardiovascular disease events. The results are consistent with the clinical trials of lipid-lowering, antihypertensive therapy. The efficacy of lowering glycohemoglobin below 7% or benefits of specific glucose-lowering drugs is still unresolved. The BARI 2D trial focused on more advanced atherosclerotic disease. An important question is whether newly incident diabetics should be screened for subclinical atherosclerosis and treated aggressively with pharmacological therapy as in the BARI 2D trial. We are still uncertain whether raising high-density lipoprotein cholesterol will provide further benefit in reducing coronary heart disease. Better measurement of plaque morphology, determinants of hypercoagulable status, and drugs to reduce thrombosis and plaque are of high priority. Longer follow-up of the BARI 2D and COURAGE trials will provide important information about the risks of cardiovascular disease events and disability. It will be important but difficult to translate the results of the trials to community practice under the current health care system.

Clinical implications of the BARI 2D and COURAGE trials: overview

The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial established that, for patients with stable coronary artery disease (CAD), an initial management strategy of percutaneous coronary intervention plus optimal medical therapy did not reduce the long-term rates of death, myocardial infarction, or other cardiovascular events as compared with optimal medical therapy alone. The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial reported that for patients with type 2 diabetes and stable CAD, a strategy of prompt coronary revascularization and intensive medical therapy did not reduce all-cause mortality or the composite of death, myocardial infarction or stroke compared with intensive medical therapy alone; however, in the group of patients appropriate for coronary artery bypass graft surgery (CABG), prompt revascularization with CABG resulted in significantly lower rates of major cardiovascular events, specifically myocardial infarction, than intensive medical therapy alone. The results from these two large multicenter clinical trials have led the medical community to re-evaluate how one should approach and treat patients with CAD and stable ischemic symptoms. In this special issue, experts from several disciplines discuss how the COURAGE and BARI 2D results have affected clinical practice and highlight the key questions that remain unanswered.

Clinical implications of the BARI 2D and COURAGE trials: the evolving role of percutaneous coronary intervention

This review outlines the evolving role of percutaneous coronary intervention (PCI) for stable angina in the context of the widely discussed Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) and Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trials. Factors outlined include defining the appropriate patient population, the clinical circumstances, and the technical aspects of the procedure to optimize clinical outcomes and minimize risk. The COURAGE Trial, as others reported earlier, reported no difference in death or myocardial infarction with PCI compared with medical therapy for stable angina. In patients with type 2 diabetes mellitus in the BARI 2D Trial, a strategy of revascularization with coronary artery bypass graft surgery (CABG) or PCI resulted in no difference in mortality compared with optimal medical therapy. However, PCI for stable angina was associated with reduced angina and improved quality of life. Procedural aspects of PCI that support its continuing role in the management of patients with stable angina include the frequent advancements in PCI technology that have further enhanced both acute and long-term success. In conclusion, the implications of these findings for clinical practice include evaluating the use of PCI for stable angina in addition to optimal medical therapy to reduce angina and improve quality of life, but individualizing care for higher risk patients with more complex coronary artery disease who were not enrolled in the COURAGE and BARI 2D trials.

Choice of initial medical therapy vs. prompt coronary revascularization in patients with type 2 diabetes and stable ischemic coronary disease with special emphasis on the BARI 2D trial results

To determine whether a strategy of prompt coronary revascularization as compared with an initial strategy of intensive optimal medical therapy (OMT) in patients with type 2 diabetes and stable coronary artery disease (CAD) prevents major adverse cardiac outcomes. Randomized controlled clinical trials comparing a strategy of prompt coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI) or medical therapy in patients with type 2 diabetes are reviewed with special emphasis on the Bypass Angioplasty Revascularization Investigation 2D trial. An initial strategy of PCI or CABG alleviates symptoms and improves quality of life more than an initial strategy of OMT. However, an initial strategy of PCI in patients with less extensive CAD does not significantly reduce death or myocardial infarction. Patients with more extensive CAD in whom a more complete coronary revascularization can be achieved with CABG have less subsequent myocardial infarction, a complication associated with increased mortality, than those treated with initial OMT. In many patients with type 2 diabetes and stable CAD in whom angina symptoms are controlled, OMT alone should be the first-line strategy. In patients with more extensive coronary disease, prompt CABG, in the absence of contraindications, OMT, and an insulin sensitization strategy are a preferred therapeutic strategy to reduce the incidence of myocardial infarction.

Treatment of type 2 diabetes: New clinical studies and effects of GLP-1 on macrovascular complications

Various publications in 2009 showed that the treatment of type 2 diabetic (T2D) patients with macrovascular complications is still a controversial subject, whether with regard to the use of glitazones, to the best management strategy for T2D patients with stable coronary artery disease or to the use of incretin mimetic drugs in patients with heart disease. The Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of glycemia in Diabetes study (RECORD) compared cardiovascular morbidity-mortality outcomes in patients taking rosiglitazone in combination with metformin or sulfonylurea versus metformin with sulfonylurea. The results showed that rosiglitazone was not inferior to the metformin-sulfonylurea combination in terms of mortality and cardiovascular hospitalization, but caution must be used when interpreting the results, as the event rate was low. The BARI 2D study (Bypass Angioplasty Revascularization Investigation 2 Diabetes) is a cardiovascular morbidity-mortality trial with the goal of determining the best strategy for blood glucose control and revascularization in T2D patients with stable coronary artery disease. The results of this trial showed that early revascularization is not clearly beneficial, except in a subgroup of patients in whom surgical revascularization is indicated. The use of GLP-1 analogs (Glucagon-Like Peptide-1) in the acute phase of myocardial ischemia in animal models provided promising results. Some clinical studies also suggest an improvement in cardiovascular risk factors with these treatments. Results from morbidity-mortality studies are needed to better assess the long-term efficiency of these new drugs.

Beyond the P Value

Ischemic heart disease is highly prevalent in the United States, affecting 17.6 million patients (≈7.9% of the adult population), and is associated with increased mortality, hospitalizations, and an estimated annual cost of $177 billion.1 Diabetes mellitus is a coexistent complication for many of the patients living with ischemic heart disease with similar short-term outcomes whether it predates or is diagnosed at the time of the initial acute coronary syndrome.2 Targets of therapy for these ischemic heart disease patients are focused on improved mortality and reduced major adverse nonfatal cardiovascular events, including myocardial infarction, unstable angina, stroke, and need for repeat revascularization. As a result in part of research advances in the management of acute coronary syndromes and implementation of primary and secondary prevention efforts, overall mortality rates attributable to ischemic heart disease in the United States have decreased dramatically since 1970 with an additional 36% decrement between 1996 and 2006.1,3 Because more patients are living with ischemic heart disease, improving quality of life or health status has emerged as an important additional target of therapy. Article see p 1690 Health status is a concept that measures the impact of a patient's illness on various parts of his or her daily life related to symptom burden, functional limitations, and quality of life.4 Although some tools such as the New York Heart Association functional classification have traditionally been assessed by physicians, more recent trends allow patients to report their health status directly, grouped as patient-reported outcomes. Quality of life is a complex measure resulting from the patient's integration of biological variables related to the disease process, symptom burden, disconnect between the desired and actual functional status, perceived prognosis, and general health perceptions.5 These concepts can be quantified with tools that have established psychometric properties and …

Health Status After Treatment for Coronary Artery Disease and Type 2 Diabetes Mellitus in the Bypass Angioplasty Revascularization Investigation 2 Diabetes Trial

Health status is a key outcome for comparing treatments, particularly when mortality does not differ significantly. Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) randomized 2368 patients with type 2 diabetes mellitus and stable ischemic heart disease to (1) prompt revascularization versus medical therapy and (2) insulin sensitization versus insulin provision. Randomization was stratified by the intended method of revascularization, coronary artery bypass graft surgery or percutaneous coronary intervention. The Duke Activity Status Index and RAND Energy, Health Distress, and Self-Rated Health scales were assessed at study entry and annually thereafter; linear mixed models were used to evaluate the effect of randomized treatment on these measures. Health status improved significantly from baseline to 1 year (P<0.001) in each randomized treatment group. Compared with medical therapy, prompt revascularization was associated with significantly greater improvements in Duke Activity Status Index (1.32 points; P<0.001), Energy (1.36 points; P=0.02), and Self-rated Health (1.77 points; P=0.007) but not Health Distress (-0.47; P=0.46). These treatment effects were largely maintained over 4 years of follow-up. The effect of revascularization on the Duke Activity Status Index was significantly larger in the subgroup of patients intended for coronary artery bypass graft surgery compared with the subgroup intended for percutaneous coronary intervention. Health status did not differ significantly on any of the 4 measures between the insulin provision and insulin sensitization strategies. Prompt coronary revascularization was associated with small yet statistically significant improvements in health status compared with initial medical therapy among patients with diabetes mellitus and stable ischemic heart disease. http://www.clinicaltrials.gov. Unique identifier: NCT00006305.

Rosiglitazone and New Insights in the BARI 2D Trial

According to post hoc analyses of the Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes [BARI 2D; NCT00006305] data, rosiglitazone is not associated with an increased risk of major adverse cardiovascular events, including myocardial infarction and death, in patients with type 2 diabetes mellitus and established coronary artery disease.

Health Insurance Status and Control of Diabetes and Coronary Artery Disease Risk Factors on Enrollment Into the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial

The purpose of this study was to examine measures of chronic disease severity and treatment according to insurance status in a clinical trial setting. Baseline insurance status of 776 patients with type 2 diabetes and stable coronary artery disease (CAD) enrolled in the United States in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial was analyzed with regard to measures of metabolic and cardiovascular risk factor control. Compared with patients with private or public insurance, the uninsured were younger, more often female, and less often white non-Hispanic. Uninsured patients had the greatest burden of CAD. Patients with public insurance were treated with the greatest number of medications, had the greatest self-reported functional status, and the lowest mean glycosylated hemoglobin and low-density lipoprotein (LDL) cholesterol values. Overall, for 5 measured risk factor targets, the mean number above goal was 2.49 ± 1.18. After adjustment for demographic and clinical variables, insurance status was not associated with a difference in risk factor control. In the BARI 2D trial, we did not observe a difference in baseline cardiovascular risk factor control according to insurance status. An important observation, however, was that risk factor control overall was suboptimal, which highlights the difficulty in treating type 2 diabetes and CAD irrespective of insurance status.

Therapeutic Strategies in Patients with Chronic Stable Coronary Artery Disease

In chronic stable angina of mild or moderate severity, there is an ongoing debate as to which treatment strategy should be offered to patients: intense medical drug therapy combined with revascularization if medical therapy fails, or direct coronary angiography in view of immediate revascularization in all patients if feasible, both combined with strict risk factor control and secondary prevention. Findings of two large randomized controlled trials, COURAGE and BARI 2D showed that in selected patients with mild to moderate angina and documented coronary disease by coronary angiography suitable for revascularization, there was no difference in death or myocardial infarction between the two strategies. It remains unclear, however, how these findings can be generalized to the broader spectrum of patients with unknown coronary anatomy. This review describes both treatment strategies, their strengths and limitations, and stresses the importance of the documentation of the extent of myocardial ischemia in risk stratifying such patients. Based on the available trial evidence, an algorithm is proposed how to tailor the management strategy to each patient's individual situation.

Coronary revascularization in patients with type 2 diabetes and results of the BARI 2D trial

This Perspective reviews the results of early and contemporary studies evaluating the safety and efficacy of coronary revascularization in patients with diabetes. It also addresses the implications of some of the data in the Bypass Angioplasty Revascularization Investigation in type 2 diabetes (BARI 2D) trial. Review of the literature and discussion of the implications of results in the BARI 2D trial. Patients with diabetes benefit from revascularization by coronary thrombolysis, percutaneous transluminal coronary angioplasty, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG). However, with each intervention the benefit is less and the risks and complications are greater than in patients without diabetes. Revascularization for treatment of ST elevation myocardial infarction increases survival. When used for treatment of non-ST elevation myocardial infarction or unstable angina, it does not except in those at very high risk. In patients with chronic, symptomatic coronary artery disease, long-term mortality is comparable after CABG or PCI. However, the incidence of major adverse cardiac events is greater after PCI primarily because of the need for more subsequent revascularization procedures. Both interventions relieve symptoms, but neither improves survival except in patients at high risk. In patients with clinically stable chronic coronary disease, survival after CABG or PCI is comparable with that in patients treated with optimal medical therapy alone. Accordingly, evaluation for revascularization can be deferred until signs and symptoms worsen except in patients at high risk. In patients at high risk survival after promptly implemented CABG is greater than that with optimal medical therapy, especially when the diabetes is being treated with insulin sensitizing agents.

Relationships of Obesity and Fat Distribution With Atherothrombotic Risk Factors: Baseline Results From the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial

The impact of obesity on cardiovascular disease (CVD) outcomes in patients with type 2 diabetes mellitus (T2DM) and established coronary artery disease (CAD) is controversial; whether BMI and/or waist circumference correlate with atherothrombotic risk factors in such patients is uncertain. We sought to evaluate whether higher BMI or waist circumference are associated with specific risk factors among 2,273 Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) study participants with T2DM and documented CAD (baseline data, mean age 62 years, 66% non-Hispanic white, 71% men). Multiple linear regression models were constructed after adjusting for sex, age, race/ethnicity, US vs. non-US site, diabetes duration, exercise, smoking, alcohol, and relevant medication use. First-order partial correlations of BMI with risk factors after controlling for waist circumference and of waist circumference with risk factors after controlling for BMI were also evaluated. Ninety percent of the patients were overweight (BMI > or =25 kg/m(2)); 68% of men and 89% of women had high-risk waist circumference measures (> or =102 and > or =88 cm, respectively). BMI and waist circumference, in separate models, explained significant variation in metabolic (insulin, lipids, blood pressure (BP)) and inflammatory/procoagulation (C-reactive protein, PAI-1 activity and antigen, and fibrinogen) risk factors. In partial correlation analyses BMI was independently associated with BP and inflammatory/procoagulation factors, waist circumference with lipids, and both BMI and waist circumference with insulin. We conclude that, in cross-sectional analyses, both BMI and waist circumference, independently, are associated with increased atherothrombotic risk in centrally obese cohorts such as the BARI 2D patients with T2DM and CAD.

High Prevalence and Diversity of Kidney Dysfunction in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease: The BARI 2D Baseline Data

BackgroundWe describe baseline renal function and albumin excretion rate in patients enrolled in Bypass Angioplasty Revascularization Investigation 2 Diabetes, a randomized clinical trial comparing the impact of revascularization and medical therapy with medical therapy alone and deferred or no revascularization and the impact of glycemic control with either insulin-providing or insulin-sensitizing drugs, on 5-year mortality. MethodsStudy participants had type 2 diabetes mellitus, documented coronary artery disease, and creatinine <2mg/dL. Albuminuria status (albumin/creatinine ratio [ACR]) and estimated glomerular filtration rate (eGFR), using the abbreviated Modified Diet in Renal Disease equation, were determined at baseline. Univariate and multivariate relationships between baseline clinical characteristics and the presence of albuminuria and reduced eGFR rate were estimated. ResultsTwo thousand one hundred forty-six subjects were included in the analysis. Forty-three percent of the cohort had evidence of kidney dysfunction at baseline: 23% had an eGFR ≥60mL/min/1.73 m2 with either microalbuminuria (>30 ACR; 17%) or macroalbuminuria (>300 ACR; 6%). Twenty-one percent had a reduced eGFR <60mL/min/1.73 m2; 52% with reduced eGFR had no albuminuria; 28% had microalbuminuria, and 20% had macroalbuminuria. Race, smoking status, duration of diabetes, hypertension, hemoglobin A1c, triglycerides, vascular disease, abnormal ejection fraction, and reduced eGFR were associated with greater albuminuria. Age, sex, duration of diabetes, ACR, hemoglobin A1c, high density lipoprotein, and number of hypertensive medications were associated with reduced eGFR. ConclusionKidney dysfunction is common in older patients with type 2 diabetes mellitus and coronary artery disease; Albuminuria was present in 33%. Reduced eGFR was present in 21%, and half the patients with reduced eGFR had no evidence of albuminuria.

Update on the Safety of Thiazolidinediones

Diabetic patients are at increased risk for developing cardiovascular disease, and they constitute a large proportion of the global cardiovascular disease burden. Although multiple drugs exist for treating the hyperglycemia associated with diabetes, few have been shown to reduce cardiovascular risk. Great hope surrounded the arrival of the thiazolidinediones-drugs that favorably affect insulin sensitivity, inflammation, and some aspects of lipid profiles in diabetic patients. However, the cardiovascular effects of these agents are varied, and studies have suggested that they may be associated with increases in ischemic heart disease and heart failure, as well as with an increased risk for bone fracture. The following article provides a summary of important studies that have been published regarding the safety profiles of these agents. Findings from two recently published trials, RECORD and BARI 2D, are emphasized in this paper.

Resting Heart Rate and Metabolic Syndrome in Patients With Diabetes and Coronary Artery Disease in Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial

The relation between the metabolic syndrome (MetS) and resting heart rate (rHR) in patients with diabetes and coronary artery disease is unknown. The authors examined the cross-sectional association at baseline between components of the MetS and rHR and between rHR and left ventricular ejection fraction in the population from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) randomized clinical trial. The mean rHR in the MetS group was significantly higher than in those without (68.4+/-12.3 vs 65.6+/-11.8 beats per min, P=.0017). The rHR was higher (P<.001 for trend) with increasing number of components for MetS. Linear regression analyses demonstrated that as compared to individuals without MetS, rHR was significantly higher in participants with MetS (regression coefficient, 2.9; P=.0015). In patients with type 2 diabetes and coronary artery disease, the presence of higher rHR is associated with increasing number of criteria of MetS and the presence of ventricular dysfunction.

BARI 2D - kam nás dovedla a co bude dál

Cíl: Dosud provedené studie nestanovily, jaká je optimální léčba pro diabetiky 2. typu se stabilní ICHS a mírnými symptomy. Studie BARI 2D navazuje na studii BARI, kde byl u diabetiků (zejména na inzulinu) podstatně horší dlouhodobý účinek revaskularizace oproti ostatním pacientům. Multicentrická klinická studie BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) probíhala v letech 2001-2008. Byla srovnávána skupina s časnou revaskularizací (ER), provedenou buď perkutánní koronární intervencí (PCI), či aortokoronárním bypassem (CABG), a skupina s konzervativní terapií (MT), spolu s intenzivní farmakoterapií a intervencí životního stylu v obou skupinách. Současně byly srovnávány dvě strategie léčby diabetu: 1) tzv. inzulinovými senzitizéry a 2) inzulinem anebo inzulinovými sekretagogy. Primárním sledovaným ukazatelem byla celková pětiletá mortalita.Metodika: 2 368 diabetiků 2. typu se stabilní ICHS a nálezem vhodným k revaskularizaci (metodu určil kardiolog) bylo randomizováno k časné revaskularizaci nebo konzervativní terapii. Současně proběhla i nezávislá randomizace ke strategii léčby diabetu - buď inzulinovými senzitizéry, či inzulinem anebo inzulinovými sekretagogy. Průměrná doba sledování byla 5,3 roku.Výsledky: Celková pětiletá mortalita byla 11,7 % (n = 137) u časné revaskularizace vs. 12,2 % (n = 145) u konzervativní terapie (p = 0,97, statisticky nesignifikantní) a 11,8 % (n = 139) při léčbě inzulinovými senzitizéry vs. 12,1 % (n = 143) při léčbě inzulinem anebo inzulinovými sekretagogy (p = 0,89, nevýznamné). Kombinovaný sekundární sledovaný ukazatel (úmrtí + nefatální IM + CMP) též nedosáhl statistické významnosti při porovnání jednotlivých skupin: časná revaskularizace oproti konzervativní terapii: 22,8 % (n = 268) vs. 24,1 % (n = 287), p = 0,70 a léčba inzulinovými senzitizéry oproti léčbě inzulinem anebo inzulinovými sekretagogy: 22,3 % (n = 264) vs. 24.6 % (n = 291), p = 0,13; rozbor dle podskupin však nalezl u skupiny určené k CABG jeho nižší výskyt ve větvi s časnou revaskularizací oproti větvi s konzervativní terapií (22,4 % vs. 30,5 %, p = 0,01).Závěr: Ani jedna z léčebných strategií nepřinesla jednoznačný prospěch v podobě snížení mortality či výskytu závažných kardiovaskulárních příhod - nebyl zjištěn významný rozdíl mezi skupinami s iniciální revaskularizací a skupinami s konzervativní terapií, ani mezi léčbou inzulinovými senzitizéry a inzulinem anebo inzulinovými sekretagogy. Jediný statisticky pozitivní výstup - méně kardiovaskulárních příhod u časně revaskularizovaných pacientů určených k CABG - nejspíše souvisí s výraznějším postižením koronárního řečiště těchto nemocných.

Racial Differences in the Association Between Self-Rated Health Status and Objective Clinical Measures Among Participants in the BARI 2D Trial

We explored whether and how race shapes perceived health status in patients with type 2 diabetes mellitus and coronary artery disease. We analyzed self-rated health (fair or poor versus good, very good, or excellent) and associated clinical risk factors among 866 White and 333 Black participants in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial. Michigan Neuropathy Screening Instrument scores, regular exercise, and employment were associated with higher self-rated health (P < .05). Blacks were more likely than were Whites to rate their health as fair or poor (adjusted odds ratio [OR] = 1.88; 95% confidence interval [CI] = 1.38, 2.57; P < .001). Among Whites but not Blacks, a clinical history of myocardial infarction (OR = 1.61; 95% CI = 1.12, 2.31; P < .001) and insulin use (OR = 1.62; 95% CI = 1.10, 2.38; P = .01) was associated with a fair or poor rating. A post-high school education was related to poorer self-rated health among Blacks (OR = 1.86; 95% CI = 1.07, 3.24; P < .001). Symptomatic clinical factors played a proportionally larger role in self-assessment of health among Whites with diabetes and coronary artery disease than among Blacks with the same conditions.