TY - JOUR
T1 - Relation of Severe Coronary Artery Narrowing to Insulin or Thiazolidinedione Use in Patients With Type 2 Diabetes Mellitus (from the Bypass Angioplasty Revascularization Investigation 2 Diabetes Study)
AU - Pop-Busui, Rodica
AU - Lombardero, Manuel
AU - Lavis, Victor
AU - Forker, Alan
AU - Green, Jennifer
AU - Korytkowski, Mary
AU - Sobel, Burton E.
AU - Jones, Teresa L.Z.
N1 - Funding Information:
The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial is funded by Grants U01 HL061746, U01 HL061748, and U01 HL063804 from the National Heart, Lung and Blood Institute (Bethesda, Maryland) and receives substantial funding (Grant HL061744) from the National Institute of Diabetes and Digestive and Kidney Diseases (Bethesda, Maryland). BARI 2D receives significant supplemental funding from GlaxoSmithKline, Lantheus Medical Imaging, Inc. (formerly Bristol-Myers Squibb Medical Imaging, Inc.), Astellas Pharma US, Inc., Merck, & Co., Inc., Abbott Laboratories, Inc., and Pfizer, Inc., and generous financial support from Abbott Laboratories, Ltd., MediSense Products, Bayer Diagnostics, Becton, Dickinson, & Company, J.R. Carlson Laboratories, Inc., Centocor, Inc., Eli Lilly and Company, LipoScience, Inc., Merck Sante, Novartis Pharmaceuticals Corporation, and Novo Nordisk, Inc. The BARI 2D trial is co-ordinated by the Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania. Dr. Sobel received Grant R01 HL71306 from the National Institutes of Health, Bethesda, Maryland.
PY - 2009/7/1
Y1 - 2009/7/1
N2 - Patients with diabetes continue to die of coronary artery disease (CAD) at rates 2 to 4 times higher than patients without diabetes, despite advances in treatment of cardiovascular disease. The role of glycemic control therapies, independent of their glucose-lowering effects, on cardiovascular disease is a recurring question. We examined the association of glycemic control therapies with extent of CAD as measured by coronary angiogram obtained at baseline in 1,803 subjects in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial who had type 2 diabetes mellitus, documented moderate to severe CAD, and no previous cardiac revascularization procedures. The association between glycemic control therapy use recorded at baseline and percent coronary artery stenosis and myocardial jeopardy index was analyzed by multiple regression models. Insulin use at study entry was associated with 23% fewer highly stenotic lesions (≥70%) (p <0.001) and a significantly lower myocardial jeopardy index compared with subjects not on insulin, despite a worse cardiac risk factor profile, more unstable angina, and increased inflammatory markers in insulin users. Subjects taking thiazolidinediones (TZDs) for ≥6 months had 17% fewer highly stenotic lesions (p = 0.02) and significantly lower C-reactive protein, fibrinogen, and plasminogen activator inhibitor-1 levels compared with those not taking TZDs. In conclusion, this cross-sectional study of patients with type 2 diabetes mellitus and CAD showed that treatment with insulin or TZDs was associated with fewer highly stenotic lesions, independent of disease duration, glycemic control, and other risk factors.
AB - Patients with diabetes continue to die of coronary artery disease (CAD) at rates 2 to 4 times higher than patients without diabetes, despite advances in treatment of cardiovascular disease. The role of glycemic control therapies, independent of their glucose-lowering effects, on cardiovascular disease is a recurring question. We examined the association of glycemic control therapies with extent of CAD as measured by coronary angiogram obtained at baseline in 1,803 subjects in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial who had type 2 diabetes mellitus, documented moderate to severe CAD, and no previous cardiac revascularization procedures. The association between glycemic control therapy use recorded at baseline and percent coronary artery stenosis and myocardial jeopardy index was analyzed by multiple regression models. Insulin use at study entry was associated with 23% fewer highly stenotic lesions (≥70%) (p <0.001) and a significantly lower myocardial jeopardy index compared with subjects not on insulin, despite a worse cardiac risk factor profile, more unstable angina, and increased inflammatory markers in insulin users. Subjects taking thiazolidinediones (TZDs) for ≥6 months had 17% fewer highly stenotic lesions (p = 0.02) and significantly lower C-reactive protein, fibrinogen, and plasminogen activator inhibitor-1 levels compared with those not taking TZDs. In conclusion, this cross-sectional study of patients with type 2 diabetes mellitus and CAD showed that treatment with insulin or TZDs was associated with fewer highly stenotic lesions, independent of disease duration, glycemic control, and other risk factors.
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U2 - 10.1016/j.amjcard.2009.02.046
DO - 10.1016/j.amjcard.2009.02.046
M3 - Article
C2 - 19576321
AN - SCOPUS:67649354215
SN - 0002-9149
VL - 104
SP - 52
EP - 58
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 1
ER -