MEDICAL RISK FACTOR CONTROL IN LARGE TRIALS OF DIABETIC PATIENTS UNDERGOING CORONARY REVASCULARIZATION


Michael E. Farkouh, M.D., University of Toronto, Toronto, Ontario, Canada

Over the past 2 decades, significant progress has been made in the medical management for patients with coronary artery disease (CAD). Despite guidelines that recommend specific targets for control of risk factors, specifically blood pressure targets in hypertensive patients, low-density lipoprotein (LDL) for those with hyperlipidemia, and glycemic control (HbA1C) in diabetic patients, current large cohort studies demonstrate that a significant proportion of patients do not achieve target risk factor control.

In this report, we further evaluate the data from three federally funded trials that focus on optimal medical therapy in patients with coronary artery disease and discuss potential barriers to achieving these targets. In this analysis, data from COURAGE, BARI-2D, and FREEDOM trials, specifically evaluating the proportion of patients that fail to achieve guideline-based targets for blood pressure, LDL, and HbA1C, were obtained from the respective principal investigators. Baseline and 1-year data from 2287 patients enrolled in COURAGE, 2368 patients in BARI-2D, and 1901 patients in FREEDOM trials, will be compared. Data from the 3 trials demonstrate that a significant number of patients fail to achieve targets for important cardiovascular risk factors as recommended by national guidelines even when optimal medical therapy is offered in the setting of large-scale clinical trials.

Future initiatives to improve control of risk factors are necessary and should be a key objective of future clinical trials in patients with CAD who are eligible for coronary revascularization.