Multifactorial Intervention

The Steno-2 study compared the efficacy of a targeted, intensified, multifactorial intervention with that of conventional treatment on modifiable risk factors for CV disease in 160 patients with diabetes and microalbuminuria.140 The primary end point was a composite of CV death, nonfatal MI, stroke, revas-cularization, and amputation. Intensive treatment was characterized by a stepwise implementation of behavior modification and pharmacologic therapy that targeted hyperglycemia, hypertension, dyslipid-emia, and microalbuminuria, along with secondary CV prevention with aspirin. Conventional treatment was in accordance with national guidelines. After a mean follow-up of 8 years, patients receiving intensive therapy had a significantly lower risk of CVD (HR = 0.47), nephropathy (HR = 0.39), retinopathy (HR = 0.42), and autonomic neuropathy (HR = 0.37). The authors concluded that a target-driven, long-term, intensified intervention aimed at multiple risk factors in patients with type 2 diabetes and microal-buminuria halves the risk of CV and microvascular events.

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