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

被引：30

作者：

Chung, Sheng-Chia

Hlatky, Mark A. ^{[2
]}

Faxon, David ^{[3
]}

Ramanathan, Kodangudi ^{[4
]}

Adler, Dale ^{[5
]}

Mooradian, Arshag ^{[6
]}

Rihal, Charanjit ^{[7
]}

Stone, Roslyn A.

Bromberger, Joyce T.

Kelsey, Sheryl F.

Brooks, Maria Mori ^{[1
]}

机构：

[1] Univ Pittsburgh, Dept Epidemiol & Biostat, GSPH, Pittsburgh, PA 15261 USA

[2] Stanford Univ, Sch Med, Stanford, CA 94305 USA

[3] Brigham & Womens Hosp, Boston, MA 02115 USA

[4] Memphis VA Med Ctr, Memphis, TN USA

[5] Case Western Reserve Univ, Sch Med, Cleveland, OH USA

[6] Univ Florida, Coll Med, Jacksonville, FL USA

[7] Mayo Clin, Rochester, MN USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2011年 / 58卷 / 08期

关键词：

age; coronary heart disease; diabetes mellitus; health status; revascularization; CORONARY-ARTERY-DISEASE; QUALITY-OF-LIFE; OPTIMAL MEDICAL THERAPY; RANDOMIZED-TRIAL; ELDERLY-PATIENTS; FOLLOW-UP; SURGERY; CARE; INFARCTION; SURVIVAL;

D O I：

10.1016/j.jacc.2011.05.020

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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) (J Am Coll Cardiol 2011;58:810-9) (C) 2011 by the American College of Cardiology Foundation

引用

页码：810 / 819

页数：10

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