The effect of age on clinical outcomes and health status: BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes)

Sheng Chia Chung, Mark A. Hlatky, David Faxon, Kodangudi Ramanathan, Dale Adler, Arshag Mooradian, Charanjit Rihal, Roslyn A. Stone, Joyce T. Bromberger, Sheryl F. Kelsey, Maria Mori Brooks

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to determine the extent to which effectiveness of cardiac and diabetes treatment strategies varies by patient age. Background: The impact of age on the effectiveness of revascularization and hyperglycemia treatments has not been thoroughly investigated. Methods: In the BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes) trial, 2,368 patients with documented stable heart disease and type 2 diabetes were randomized to receive prompt revascularization versus initial medical therapy with deferred revascularization and insulin sensitization versus insulin provision for hyperglycemia treatment. Patients were followed for an average of 5.3 years. Cox regression and mixed models were used to investigate the effect of age and randomized treatment assignment on clinical and health status outcomes. Results: The effect of prompt revascularization versus medical therapy did not differ by age for death (interaction p = 0.99), major cardiovascular events (interaction p = 0.081), angina (interaction p = 0.98), or health status outcomes. After intervention, participants of all ages had significant angina and health status improvement. Younger participants experienced a smaller decline in health status during follow-up than older participants (age by time interaction p < 0.01). The effect of the randomized glycemia treatment on clinical and health status outcomes was similar for patients of different ages. Conclusions: Among patients with stable heart disease and type 2 diabetes, the relative beneficial effects of a strategy of prompt revascularization versus initial medical therapy and insulin-sensitizing versus insulin-providing therapy on clinical endpoints, symptom relief, and perceived health status outcomes do not vary by age. Health status improved significantly after treatment for all ages, and this improvement was sustained longer among younger patients. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes [BARI 2D]; NCT00006305)

Original languageEnglish (US)
Pages (from-to)810-819
Number of pages10
JournalJournal of the American College of Cardiology
Volume58
Issue number8
DOIs
StatePublished - Aug 16 2011

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Angioplasty
Type 2 Diabetes Mellitus
Health Status
Insulin
Therapeutics
Hyperglycemia
Heart Diseases

Keywords

  • age
  • coronary heart disease
  • diabetes mellitus
  • health status
  • revascularization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The effect of age on clinical outcomes and health status : BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes). / Chung, Sheng Chia; Hlatky, Mark A.; Faxon, David; Ramanathan, Kodangudi; Adler, Dale; Mooradian, Arshag; Rihal, Charanjit; Stone, Roslyn A.; Bromberger, Joyce T.; Kelsey, Sheryl F.; Brooks, Maria Mori.

In: Journal of the American College of Cardiology, Vol. 58, No. 8, 16.08.2011, p. 810-819.

Research output: Contribution to journalArticle

Chung, SC, Hlatky, MA, Faxon, D, Ramanathan, K, Adler, D, Mooradian, A, Rihal, C, Stone, RA, Bromberger, JT, Kelsey, SF & Brooks, MM 2011, 'The effect of age on clinical outcomes and health status: BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes)', Journal of the American College of Cardiology, vol. 58, no. 8, pp. 810-819. https://doi.org/10.1016/j.jacc.2011.05.020
Chung, Sheng Chia ; Hlatky, Mark A. ; Faxon, David ; Ramanathan, Kodangudi ; Adler, Dale ; Mooradian, Arshag ; Rihal, Charanjit ; Stone, Roslyn A. ; Bromberger, Joyce T. ; Kelsey, Sheryl F. ; Brooks, Maria Mori. / The effect of age on clinical outcomes and health status : BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes). In: Journal of the American College of Cardiology. 2011 ; Vol. 58, No. 8. pp. 810-819.
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abstract = "Objectives: The purpose of this study was to determine the extent to which effectiveness of cardiac and diabetes treatment strategies varies by patient age. Background: The impact of age on the effectiveness of revascularization and hyperglycemia treatments has not been thoroughly investigated. Methods: In the BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes) trial, 2,368 patients with documented stable heart disease and type 2 diabetes were randomized to receive prompt revascularization versus initial medical therapy with deferred revascularization and insulin sensitization versus insulin provision for hyperglycemia treatment. Patients were followed for an average of 5.3 years. Cox regression and mixed models were used to investigate the effect of age and randomized treatment assignment on clinical and health status outcomes. Results: The effect of prompt revascularization versus medical therapy did not differ by age for death (interaction p = 0.99), major cardiovascular events (interaction p = 0.081), angina (interaction p = 0.98), or health status outcomes. After intervention, participants of all ages had significant angina and health status improvement. Younger participants experienced a smaller decline in health status during follow-up than older participants (age by time interaction p < 0.01). The effect of the randomized glycemia treatment on clinical and health status outcomes was similar for patients of different ages. Conclusions: Among patients with stable heart disease and type 2 diabetes, the relative beneficial effects of a strategy of prompt revascularization versus initial medical therapy and insulin-sensitizing versus insulin-providing therapy on clinical endpoints, symptom relief, and perceived health status outcomes do not vary by age. Health status improved significantly after treatment for all ages, and this improvement was sustained longer among younger patients. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes [BARI 2D]; NCT00006305)",
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AU - Faxon, David

AU - Ramanathan, Kodangudi

AU - Adler, Dale

AU - Mooradian, Arshag

AU - Rihal, Charanjit

AU - Stone, Roslyn A.

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KW - diabetes mellitus

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