Relationship of glycemia control to lipid and blood pressure lowering and atherosclerosis: the SANDS experience

Mete, Mihriye; Wilson, Charlton; Lee, Elisa T.; Silverman, Angela; Russell, Marie; Stylianou, Mario; Umans, Jason G.; Wang, Wenyu; Howard, Wm. J.; Ratner, Robert E.; Howard, Barbara V.; Fleg, Jerome L.

doi:10.1016/j.jdiacomp.2011.04.001

« Previous Next »Journal of Diabetes and Its Complications
Volume 25, Issue 6 , Pages 362-367, November 2011

Relationship of glycemia control to lipid and blood pressure lowering and atherosclerosis: the SANDS experience☆

Mihriye Mete
- MedStar Health Research Institute, Hyattsville, MD, USA
Charlton Wilson
- Phoenix Indian Medical Center, Phoenix, AZ, USA
Elisa T. Lee
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
Angela Silverman
- MedStar Health Research Institute, Hyattsville, MD, USA
Marie Russell
- Phoenix Indian Medical Center, Phoenix, AZ, USA
Mario Stylianou
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
Jason G. Umans
- MedStar Health Research Institute, Hyattsville, MD, USA
Wenyu Wang
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
Wm. J. Howard
- Washington Hospital Center, Washington, DC, USA
Robert E. Ratner
- MedStar Health Research Institute, Hyattsville, MD, USA
Barbara V. Howard
- MedStar Health Research Institute, Hyattsville, MD, USA
- Corresponding author. MedStar Health Research Institute, Georgetown University, 6525 Belcrest Road, Ste. 700, Hyattsville, MD 20782, USA. Tel.: +1 301 560 7302; fax: +1 301 560 7307.
Jerome L. Fleg
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA

Received 13 October 2010; received in revised form 28 March 2011; accepted 29 April 2011. published online 20 July 2011.

Abstract

Objectives

Cardiovascular disease prevention for patients with type 2 diabetes is accomplished through hypertension and dyslipidemia management. Although studies have established strategies for lowering low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP), none have examined whether glycemia influences ability to achieve lipid and BP targets. This post hoc analysis from the Stop Atherosclerosis in Native Diabetics Study examines the role of baseline glycemia in achieving standard and aggressive targets and outcomes after 36 months.

Methods

Diabetic individuals aged >40 years with no cardiovascular events (n=499) were randomized to aggressive versus standard targets for LDL-C, non-high-density lipoprotein cholesterol (non-HDL-C) and systolic BP (SBP). Management algorithms were used for both groups. Carotid ultrasound and echocardiography were performed at baseline and after 36 months.

Results

No differences were observed in baseline hemoglobin A1c between treatment groups nor any significant change in A1c after 36 months in either group. Baseline A1c, however, was significantly and negatively related to achieving LDL-C (P=.007), non-HDL-C (P=.03) and SBP targets (P=.007) and to changes in LDL-C (P=.007), non-HDL-C (P=.03) and SBP (P=.001) in both groups. Baseline A1c failed to predict progression of carotid intima medial thickness (CIMT) (P=.42) or left ventricular mass index (LVMI) (P=.10), nor was it related to the effects of lipid and BP lowering on CIMT and LVMI over 36 months.

Conclusions

In diabetic adults with no cardiovascular disease events, A1c was negatively associated with ability to achieve LDL-C, non-HDL-C and SBP goals but was not independently related to treatment-associated changes in CIMT or LVMI over 36 months.

Keywords: LDL-C, A1c, Cardiovascular disease, Carotid arteries, Diabetes