the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Study GroupBackground-In the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial, an initial strategy of coronary revascularization and optimal medical treatment (REV) compared with an initial optimal medical treatment with the option of subsequent revascularization (MED) did not reduce all-cause mortality or the composite of cardiovascular death, myocardial infarction, and stroke in patients with type 2 diabetes mellitus and stable ischemic heart disease. In the same population, we tested whether the REV strategy was superior to the MED strategy in preventing worsening and new angina and subsequent coronary revascularizations. Methods and Results-Among the 2364 men and women (mean age, 62.4 years) with type 2 diabetes mellitus, documented coronary artery disease, and myocardial ischemia, 1191 were randomized to the MED and 1173 to the REV strategy preselected in the percutaneous coronary intervention (796) and coronary artery bypass graft (377) strata. Compared with the MED strategy, the REV strategy at the 3-year follow-up had a lower rate of worsening angina (8% versus 13%; PϽ0.001), new angina (37% versus 51%; Pϭ0.001), and subsequent coronary revascularizations (18% versus 33%; PϽ0.001) and a higher rate of angina-free status (66% versus 58%; Pϭ0.003). The coronary artery bypass graft stratum patients were at higher risk than those in the percutaneous coronary intervention stratum, and had the greatest benefits from REV. Conclusions-In these patients, the REV strategy reduced the occurrence of worsening angina, new angina, and subsequent coronary revascularizations more than the MED strategy. The symptomatic benefits were observed particularly for high-risk patients. Clinical Trial Registration-URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00006305.
Among patients with diabetes and stable ischemic heart disease, higher SYNTAX scores predict higher rates of major cardiovascular events and were associated with more favorable outcomes of revascularization compared with medical therapy among patients suitable for CABG. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes; NCT00006305).
Background. Research has shown less aggressive treatment and poorer control of cardiovascular disease (CVD) risk factors in women than men. Methods. We analyzed sex differences in pharmacotherapy strategies and attainment of goals for hemoglobin A1c (HbA1c), blood pressure (BP), and low density lipoprotein cholesterol (LDL-C) in patients with type 2 diabetes and established coronary artery disease enrolled into the BARI 2D trial. Results. Similar numbers of drugs were prescribed in both women and men. Women were less frequent on metformin or sulfonylurea and more likely to take insulin and to be on higher doses of hydroxymethylglutaryl-CoA reductase inhibitors (statins) than men. After adjusting for baseline differences and treatment prescribed, women were less likely to achieve goals for HbA1c (OR = 0.71, 95% CI 0.57, 0.88) and LDL-C (OR = 0.64, 95% CI 0.53, 0.78). More antihypertensives were prescribed to women, and yet BP ≤ 130/80 mmHg did not differ by sex. Conclusions. Women entering the BARI 2D trial were as aggressively treated with drugs as men. Despite equivalent treatment, women less frequently met targets for HbA1c and LDL-C. Our findings suggest that there may be sex differences in response to drug therapies used to treat diabetes, hypertension, and hyperlipidemia.
ABSTRACT. The effect of Passiflora incarnata's extract (PE) on gonadal maturation in young tilapia (Oreochromis sp.) was evaluated by administering feed supplemented with PE during the first 90 days immediately after yolk sac assimilation. One hundred and fifty fishes with 0.01 ± 0.003 g average body weight were randomly distributed in ten tanks with the following duplicated treatments: commercial feed (NAT), NAT with 60 mg kg -1 of 17-MT (MET), and NAT supplemented with 31.10 mg, 62.30 mg and 124.60 mg of PE g -1 (P1, P2, P3 respectively). There were no significant differences (P > 0.05) in the average body weight or in the male-female sex ratio between the experimental treatments (P1, P2, P3) and the control (NAT). Statistical differences in the gonadosomatic index (GSI) and the percentage distribution of gonadal maturation stages (PDGMS) were observed in females of P2 and P3. With respect to the females of NAT, the treatments P2 and P3 presented a lower GSI and a lower percentage of females in stage III (GSI: 1.11 ± 0.88, 1.04 ± 0.99 and 1.71 ± 0.72; PDGMS: 45, 30 and 80%, respectively). No significant differences in GSI or PDGMS were observed in the males. The results suggest that the observed differences in GSI and PDGMS in females are unrelated to antinutritional effects. Instead, these differences could be due to a possible antiestrogenic effect attributed to the possible anti-aromatase action of some of its compounds. Future research focusing on the use of PE for reproductive control in tilapia is suggested.
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