BARI 2D Trial Shows Differences Between Men and Women With Type 2 Diabetes and CAD
Results of the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial published on Feb. 26 in the Journal of the American College of Cardiology showed that while there were no differences between men and women enrolled in the trial in death, myocardial infarction (MI), or cerebrovascular accident (CVA), compared with men, women had more symptoms and less anatomic disease at baseline, with persistence of higher angina rates and lower Duke Activity Status Index scores following 5 years of medical therapy with or without prompt revascularization.
The BARI 2D trial was an international multi-center randomized clinical trial that evaluated the optimal treatment for patients with type 2 diabetes mellitus (DM) and documented coronary artery disease (CAD). At the start of the trial, it was noted that women were more likely than men to have angina (67 percent vs. 58 percent p<0.01) although they shows less disease on angiography (myocardial jeopardy index 41 ± 24 vs. 46 ± 24, p<0.01; number of significant lesion 2.3 ± 1.7 vs. 2.8 ± 1.8, p<0.01). Although there was no difference in death, MI, or CVA (Death/MI/CVA: HR 1.11, 99 percent CI 0.85-1.44), the study found that women had more symptoms and less anatomic disease at baseline than men (adjusted odds ratio = 1.51, 99 percent, CI 1.21-1.89, p<0.0001). In addition, women were more likely to show persistence of higher angina rates and lower Duke Activity Status Index (DASI) scores proceeding five years of medical therapy with or without prompt revascularization (Adjusted β coefficient: -1.58, 99 percent, CI -2.84, -0.32, p<0.01).
The authors note that these findings offer important insight into clinical care of patients with type 2 DM and stable CAD and conclude that in women with established CAD, “consideration should be given to more aggressive therapies aimed at treatment of angina and individually prescribed physical activity programs aimed at improvement in functional capacity.”
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