TY - JOUR
T1 - The effect of age on clinical outcomes and health status
T2 - BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes)
AU - Chung, Sheng Chia
AU - Hlatky, Mark A.
AU - Faxon, David
AU - Ramanathan, Kodangudi
AU - Adler, Dale
AU - Mooradian, Arshag
AU - Rihal, Charanjit
AU - Stone, Roslyn A.
AU - Bromberger, Joyce T.
AU - Kelsey, Sheryl F.
AU - Brooks, Maria Mori
N1 - Funding Information:
BARI 2D is funded by the National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases , grant nos. U01 HL061744 , U01 HL061746 , U01 HL061748 , and U01 HL063804 . Significant supplemental funding is provided by GlaxoSmithKline, Bristol-Myers Squibb Medical Imaging, Inc., Astellas Pharma US, Inc., Merck & Co., Inc., Abbott Laboratories, Inc., and Pfizer, Inc. Generous support is given by Abbott Laboratories Ltd., MediSense Products, Bayer Diagnostics, Becton, Dickinson and Company, J. R. Carlson Labs, Centocor, Inc., Eli Lilly and Company, LipoScience, Inc., Merck Sante, Novartis Pharmaceuticals Corporation, and NovoNordisk, Inc. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, or the National Institutes of Health. Dr. Faxon has served on the advisory board/data and safety monitoring board of Boston Scientific and Sanofi-Aventis; and has stock options in Riva Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Dareen McGuire, MD, served as Guest Editor for this paper.
PY - 2011/8/16
Y1 - 2011/8/16
N2 - 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)
AB - 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)
KW - age
KW - coronary heart disease
KW - diabetes mellitus
KW - health status
KW - revascularization
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U2 - 10.1016/j.jacc.2011.05.020
DO - 10.1016/j.jacc.2011.05.020
M3 - Article
C2 - 21835316
AN - SCOPUS:80051616155
SN - 0735-1097
VL - 58
SP - 810
EP - 819
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 8
ER -