Clinical StudiesThe effect of interventions to prevent cardiovascular disease in patients with type 2 diabetes mellitus☆
Section snippets
Study selection
From a MEDLINE database (1966 to 2000), we identified randomized controlled trials, published in English, involving adults with type 2 diabetes. Diabetic patients were either the focus of studies or subgroups of larger trials. We used specific terms to identify trials of cholesterol-lowering, blood pressure–lowering, and glucose-lowering therapies. Search details are available upon request. We supplemented the search with an examination of reference lists from initially identified trials and
Study and patient characteristics
In all lipid-lowering trials, diabetic patients were a small subset of the study population (Table 1). Baseline cholesterol levels varied, ranging from LDL cholesterol 135 mg/dL or lower in the Cholesterol and Recurrent Events Trial (CARE) (5) and the Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial (VA-HIT) (26) to higher than 200 mg/dL in the Helsinki Heart Study (21). In the Helsinki Heart Study, Air Force/Texas Coronary Arteriosclerosis Prevention Study
Discussion
In our analysis of diabetic subpopulations in lipid-lowering trials, the point estimates for all outcomes indicated large reductions in cardiovascular events. These effects were statistically significant for aggregate cardiac events and myocardial infarction. The benefits of antihypertensive agents were large and significant across all outcomes and for the majority of substudy analyses. In contrast, glucose lowering had a marginally significant effect on cardiovascular outcomes. Of note, the
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This study was supported by Public Health National Research Service Award PE-11001; the American Diabetes Association; SmithKline Beecham, Research Triangle Park, North Carolina; and Health Resources and Service Administration Award 2D08-PE-50018.