2143-PUB: Beneficial Impact of a Routine Clinical Practice Multifactorial Approach on the Progression of Subclinical Arterial Disease in Type 2 Diabetes: 3.2 Years Follow-Up Study

Abstract

Diabetes is associated with higher incidence of cardiovascular (CV) disease complications due to accelerated arterial damage. The beneficial effect of multi-factorial treatment of CV risk factors in type 2 diabetes is well established from randomized clinical trials. We prospectively examined the impact of such a treatment in a real-world setting, on the development of subclinical arterial damage (SAD), as determined by structural and functional non-invasive biomarkers of vascular pathology (atheromatosis [presence of atheromatous plaques in carotid/femoral arteries, ankle-brachial index], arteriosclerosis [carotid-femoral pulse wave velocity, carotid distensibility], carotid hypertrophy [intima-media thickness, cross-sectional wall artery area]). We prospectively studied 116 persons with type 2 diabetes, treated with a multi-factorial approach of CV risk factors in routine clinical practice at a tertiary medical center, and 324 individuals without diabetes, for 3.2 years. The primary outcome was changes in vascular biomarkers related to SAD. At baseline, participants in the diabetes group had higher prevalence of subclinical arterial disease. At study end, changes in clinical, biochemical and lifestyle characteristics, as well as antihypertensive and lipid-lowering treatments, were comparable between the two groups. During follow-up, classical CV risk factors (smoking, blood pressure, LDL-cholesterol, triglycerides), and behavioral features were significantly improved in both groups. Multivariate analysis, after adjusting for all classical CV risk factors and use of anti-hypertensive/lipid-lowering therapies, demonstrated that all evaluated SAD biomarkers were similarly changed between the two groups. Implementation of a multi-modality approach of type 2 diabetes treatment is feasible and effective in decelerating progression rates of SAD in routine clinical practice.