Long-term Reduction in Coronary Artery Disease and Stroke with 7,8 Years of Intensified, Multifactorial Intervention in Patients with Type 2 Diabetes and Microalbuminuria in the Steno-2 Study

Introduction: Intensified multifactorial intervention for 7.8 years in patients with type 2 diabetes mellitus and microalbuminuria increased life length and reduces complication rates. The present analysis is a sub-study examining the long-term effects specifically on coronary artery disease (CAD) and cerebrovascular disease. Methods: The original intervention (mean treatment duration 7.8 years) involved 160 patients with type 2 diabetes mellitus and microalbuminuria that were randomly assigned to either conventional therapy or intensified, multifactorial treatment including both behavioral and pharmacological approaches. After 7.8 years the study continued as an observational follow-up with all patients offered treatment as for the original intensive-therapy group. The primary end-point of this sub-analysis of the follow-up, 21.2 years after intervention start was the relative risk reduction in CAD (defined as non-fatal acute myocardial infarction or cardiac revascularization) and cerebrovascular disease (defined as non-fatal ischemic or hemorrhagic stroke) and the secondary end-point was a composite of CAD, stroke and death from cardiovascular disease. Results: Hazard rates of CAD, stroke and the composite end-point were all significantly decreased in the intensive-therapy group with HR of 0.43 [95 % CI 0.23 - 0.77; p = 0.005], 0.26 [95 % CI 0.12 - 0.55; p Conclusions: At 21.2 years of follow up of 7.8 years of intensified, multifactorial, target driven treatment of type 2 diabetes mellitus with microalbuminuria, we demonstrate significant risk reductions in coronary and cerebral artery disease.