Diabetic patients with atrial fibrillation obtained greater absolute benefits from BP-lowering treatment than did those without in a study of more than 11,000 patients with type 2 diabetes.
The study findings suggest that an estimated 5 years of active blood pressure-lowering treatment would prevent one cardiovascular death among every 42 patients with atrial fibrillation (AF) at baseline, compared with one death among 120 patients without AF, said Dr. Xin Du of the University of Sydney, and associates (Eur. Heart J. 2009 March 12 [doi:10.1093/eurheartj/ehp055
AF was present at baseline in 847 (7.6%) of the 11,140 patients with type 2 diabetes who participated in the Action in Diabetes and Vascular Disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study, which was jointly funded by the National Health and Medical Research Council of Australia and Servier, France. The outcomes measured were all-cause mortality cardiovascular death, MI, stroke, and heart failure.
Over a mean follow-up of 4.3 years, 879 patients died. Of those deaths, 468 (53%) were due to cardiovascular causes and 15% of the total deaths occurred in patients with AF. Patients with AF at baseline had significantly higher rates of both all-cause and cardiovascular mortality, at 3.9% and 2.4%, respectively, than did those who did not have AF, whose all cause and cardiovascular mortality rates were 1.7% and 0.9%, respectively.
After adjustment for covariates, those hazard ratios were 1.61 and 1.77, respectively. Patients with AF also had higher risk of major cerebrovascular events, with a hazard ratio of 1.68 that was similar for ischemic and hemorrhagic subtypes, reported the authors, several of whom other than Dr. Du have received lecture fees or grant support from, or served on an advisory board for, Servier.