Does early intensive multifactorial therapy reduce modelled cardiovascular risk in individuals with screen-detected diabetes? Results from the ADDITION-Europe cluster randomized trial.
Bottom Line: In the absence of long-term data on hard outcomes, we described change in 10-year modelled cardiovascular risk in the 5 years following diagnosis, and quantified the impact of intensive treatment on 10-year modelled cardiovascular risk at 5 years.Compared with routine care, 10-year modelled cardiovascular disease risk was lower in the intensive treatment group at 5 years.Our results suggest that patients benefit from intensive treatment early in the diabetes disease trajectory, where the rate of cardiovascular disease risk progression may be slowed.
Affiliation: MRC Epidemiology Unit, Cambridge University Biomedical Campus, Cambridge, UK.Show MeSH
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Mentions: Within all four centres, cardiovascular disease risk was lower in the intensive treatment group compared with the routine care group at 5 years (Fig. 2). The difference between groups ranged from –0.9% (95% CI –3.6 to 1.7) in Cambridge to –4.8% (95% CI –8.4 to –1.3) in the Netherlands. There was moderate variation between centres (I2 = 53.6%). When results from each centre were combined, 10-year modelled cardiovascular disease risk was significantly lower: –2.0%; 95% CI –3.1 to –0.9 in the intensive treatment group, after adjustment for baseline cardiovascular disease risk and clustering. Sensitivity analyses suggest that this result was robust to data missing not at random (see Supporting Information, Fig. S3). Similarly, results remained the same when individuals with prevalent or incident cardiovascular disease were excluded, and when individuals with missing data for smoking at 5 years were excluded (see Supporting Information, Fig. S3).
Affiliation: MRC Epidemiology Unit, Cambridge University Biomedical Campus, Cambridge, UK.