The Effect of Age on Clinical Outcomes and Health Status: BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes)

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• 作者：Sheng-Chia Chung PhD ; Mark A. Hlatky MD^† ; ; David Faxon MD^‡ ; ; Kodangudi Ramanathan MD^§ ; ; Dale Adler MD ; Arshag Mooradian MD^¶ ; ; Charanjit Rihal MD^# ; Roslyn A. Stone PhD ; Joyce T. Bromberger PhD ; Sheryl F. Kelsey PhD ; Maria Mori Brooks PhD ; ^{mbrooks@pitt.edu"" rel=""nofollow} ; BARI 2D Study Group
• 关键词：age ; coronary heart disease ; diabetes mellitus ; health status ; revascularization
• 刊名：Journal of the American College of Cardiology
• 出版年：2011
• 出版时间：16 August 2011
• 年：2011
• 卷：58
• 期：8
• 页码：810-819
• 全文大小：1554 K

文摘

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)