Learning from large cardiovascular clinical trials: classical cardiovascular risk factors

Abstract

The number of cardiovascular risk factors significantly influences age adjusted cardiovascular death rates according to the data of the MRFIT Trial. Up to 60% of patients with Type 2 diabetes have concomitant hypertension. In the HOT (Hypertension Optimal Treatment) Study lowering of blood pressure was particularly beneficial in the subgroup of diabetes mellitus: there was a 51% reduction in major cardiovascular events in target group<or=80 mmHg, compared with target group<or=90 mmHg (p=0.005). Analysis of the diabetic patient group in the CAPPP (The CAPtopril Prevention Project) showed that captopril was superior for preventing cardiovascular events in hypertensive patients with diabetes. In the diabetic cohort of the LIFE Study losartan was more effective than athenolol in reducing cardiovascular morbidity and mortality as well as mortality from all causes in patients with hypertension, diabetes and left ventricular hypertrophy. In the Heart Protection Study 5963 people with diabetes were studied. For the first occurrence of any major vascular events among diabetic participants, there was a 22% reduction in the event rate simvastatin-allocated versus placebo allocated patients (p<0.0001). DAIS (Diabetes Atherosclerosis Intervention Study) data suggest that treatment with fenofibrate reduces the angiographic progression of coronary artery disease in patients with Type 2 diabetes. According to results on multifactorial intervention in patients with Type 2 diabetes (the STENO-2 study) the overall cardiovascular risk reduction was 53%. In conclusion, management of cardiovascular risk factors should be considered as the cornerstone of diabetes care.