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      Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.

      The New England journal of medicine

      therapeutic use, Amputation, Vitamins, prevention & control, Stroke, Smoking Cessation, Risk Factors, Obesity, Myocardial Infarction, Middle Aged, Male, Hypolipidemic Agents, Hypoglycemic Agents, drug therapy, complications, Hypertension, therapy, Hyperlipidemias, Humans, Female, Exercise, Diet, Fat-Restricted, Diabetes Mellitus, Type 2, diet therapy, Diabetes Mellitus, Combined Modality Therapy, mortality, Cardiovascular Diseases, Antihypertensive Agents, Angiotensin-Converting Enzyme Inhibitors, antagonists & inhibitors, Angiotensin II

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          Abstract

          Cardiovascular morbidity is a major burden in patients with type 2 diabetes. In the Steno-2 Study, we compared the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment on modifiable risk factors for cardiovascular disease in patients with type 2 diabetes and microalbuminuria. The primary end point of this open, parallel trial was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, revascularization, and amputation. Eighty patients were randomly assigned to receive conventional treatment in accordance with national guidelines and 80 to receive intensive treatment, with a stepwise implementation of behavior modification and pharmacologic therapy that targeted hyperglycemia, hypertension, dyslipidemia, and microalbuminuria, along with secondary prevention of cardiovascular disease with aspirin. The mean age of the patients was 55.1 years, and the mean follow-up was 7.8 years. The decline in glycosylated hemoglobin values, systolic and diastolic blood pressure, serum cholesterol and triglyceride levels measured after an overnight fast, and urinary albumin excretion rate were all significantly greater in the intensive-therapy group than in the conventional-therapy group. Patients receiving intensive therapy also had a significantly lower risk of cardiovascular disease (hazard ratio, 0.47; 95 percent confidence interval, 0.24 to 0.73), nephropathy (hazard ratio, 0.39; 95 percent confidence interval, 0.17 to 0.87), retinopathy (hazard ratio, 0.42; 95 percent confidence interval, 0.21 to 0.86), and autonomic neuropathy (hazard ratio, 0.37; 95 percent confidence interval, 0.18 to 0.79). A target-driven, long-term, intensified intervention aimed at multiple risk factors in patients with type 2 diabetes and microalbuminuria reduces the risk of cardiovascular and microvascular events by about 50 percent. Copyright 2003 Massachusetts Medical Society

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          Journal
          10.1056/NEJMoa021778
          12556541

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