Effective treatment strategies to reduce the CAD burden in T2D are needed. We investigated whether progression of CAD, evaluated by ICA, could be modulated with a hospital-based multi-intervention (MULTI) to reduce cardiovascular (CV) risk. Patients with T2D and ≥ 1 CV risk factor (n=56, 21% women, age/T2D duration 57.9±7.9/5.8±5.6 years, HbA1c 7.4±1.6%, systolic BP 139±19 mmHg, LDL-cholesterol 2.8±0.9 mmol/L) were randomized to 2 years of MULTI (n=30), or standard care (STAND) by general physicians (n=26), with a pre-planned follow-up at year 7. ICA was performed at baseline (BL) and year 7. At BL 21 (36%) had no CAD, 17 (29%) wall changes, 4 (7%) 25-50% stenosis and 14 (24%) >50% stenosis. Angiograms were scored as: grade 0:<25% stenosis (st), 1:<50% st, 2: <75% st, 3: >75% st, 4: occlusion. CAD burden was described by the extent score (sc) (number of segments graded ≥1, adjusted to 16 segments) and severity sc (average gr of the diseased segments graded ≥1). After 2 years of intervention, CV risk factors in MULTI (HbA1c, systolic BP, LDL-cholesterol) were reduced, without between-group differences in CAD progression at year 7 (Table). Our data indicate that asymptomatic T2D patients have extensive CAD that increases over time and is not modulated by a 2-year multi-intervention. This suggests a need for more durable CV risk management using alternative approaches.

Progression of CAD from baseline to 7 years in the two treatment groups

  T2D population 
  Baseline 7 years 
  MULTI (n=30) STAND (n=26) MULTI (n=30) STAND (n=26)  
CAD progression Extent Score 0.038±0.067 0.078±0.12 0.050±0.081 0.10±0.11 0.30* 
Severity Score 0.47±0.84 0.83±1.11 0.67±0.98 1.18±1.06 0.20* 
  T2D population 
  Baseline 7 years 
  MULTI (n=30) STAND (n=26) MULTI (n=30) STAND (n=26)  
CAD progression Extent Score 0.038±0.067 0.078±0.12 0.050±0.081 0.10±0.11 0.30* 
Severity Score 0.47±0.84 0.83±1.11 0.67±0.98 1.18±1.06 0.20* 

*p for between-group difference in change from baseline to 7 years by ANCOVA Abbreviations: CAD: coronary artery disease, T2D: type 2 diabetes, MULTI: multi-intervention, STAND: standard care. Data given as mean±standard deviation.

Disclosure

A.P. Ofstad: Employee; Self; Boehringer Ingelheim GmbH. S. Arora: None. G.R. Ulimoen: None. K.I. Birkeland: Research Support; Self; AstraZeneca, Novo Nordisk A/S, Eli Lilly and Company, Sanofi, Boehringer Ingelheim GmbH, Merck Sharp & Dohme Corp.. K. Endresen: None. L.L. Gullestad: None. O. Johansen: Employee; Self; Boehringer Ingelheim GmbH.

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