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Articles by Robert E. Ratner
Total Records ( 2 ) for Robert E. Ratner
  Charlton Wilson , Chun-Chih Huang , Nawar Shara , Barbara V. Howard , Jerome L. Fleg , Jeffrey A. Henderson , Wm. James Howard , Heather Huentelman , Elisa T. Lee , Mihriye Mete , Marie Russell , James M. Galloway , Angela Silverman , Mario Stylianou , Jason Umans , Matthew R. Weir , Fawn Yeh and Robert E. Ratner
  Background: The Stop Atherosclerosis in Native Diabetics Study (SANDS) reported cardiovascular benefit of aggressive versus standard treatment targets for both low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) in diabetic individuals. Objective: In this analysis, we examined within trial cost-effectiveness of aggressive targets of LDL-C ≤70 mg/dL and systolic BP ≤115 mmHg versus standard targets of LDL-C ≤100 mg/dL and systolic BP ≤130 mmHg. Design: Randomized, open label blinded-to-endpoint 3-year trial. Data Sources: SANDS clinical trial database, Quality of Wellbeing survey, Centers for Medicare and Medicaid Services, Wholesale Drug Prices. Target Population: American Indians ≥age 40 years with type 2 diabetes and no previous cardiovascular events. Time Horizon: April 2003 to July 2007. Perspective: Health payer. Interventions: Participants were randomized to aggressive versus standard groups with treatment algorithms defined for both. Outcome Measures: Incremental cost-effectiveness. Results of Base-Case Analysis: Compared with the standard group, the aggressive group had slightly lower costs of medical services (−$116) but a 54% greater cost for BP medication ($1,242) and a 116% greater cost for lipid-lowering medication ($2,863), resulting in an increased cost of $3,988 over 3 years. Those in the aggressively treated group gained 0.0480 quality-adjusted life-years (QALY) over the standard group. When a 3% discount rate for costs and outcomes was used, the resulting cost per QALY was $82,589. Results of Sensitivity Analysis: The use of a 25%, 50%, and 75% reduction in drug costs resulted in a cost per QALY of $61,329, $40,070, and $18,810, respectively. Limitations: This study was limited by use of a single ethnic group and by its 3-year duration. Conclusions: Within this 3-year study, treatment to lower BP and LDL-C below standard targets was not cost-effective because of the cost of the additional medications required to meet the lower targets. With the anticipated availability of generic versions of the BP and lipid-lowering drugs used in SANDS, the cost-effectiveness of this intervention should improve.
  Wm. James Howard , Marie Russell , Jerome L. Fleg , Mihriye Mete , Tauqeer Ali , Richard B. Devereux , James M. Galloway , James D. Otvos , Robert E. Ratner , Mary J. Roman , Angela Silverman , Jason G. Umans , Neil J. Weissman , Charlton Wilson and Barbara V. Howard


Lowering low-density lipoprotein cholesterol (LDL-C) with statins reduces atherosclerosis. LDL and high-density lipoprotein (HDL) are commonly measured by their cholesterol content, but non-HDL cholesterol, LDL particle number (LDL-P), or total apolipoprotein B (apoB) may be better predictors of cardiovascular risk. Few studies have examined the relationship among lipoprotein levels and composition before and after interventions to lower LDL-C and non-HDL-C.


We sought to measure changes in carotid artery intimal media thickness (CIMT) and lipid concentration and composition during 36 months of statin therapy.


Analyses were conducted on 418 diabetic individuals, with complete data and no previous cardiovascular events, who were randomized to aggressive (AG) versus standard treatment for LDL-C, non-HDL-C, and systolic blood pressure as part of the Stop Atherosclerosis in Native Diabetics Study (SANDS).


The AG group achieved average LDL-C and non-HDL-C of 71 mg/dL and 100 mg/dL and a decrease in CIMT. No significant interactions were observed between treatment effect and initial levels of LDL-C, non-HDL-C, HDL-C, triglycerides, apoB, or LDL-P. Decreases in LDL-C (P < .005) and non-HDL-C (P < .001) were independently correlated with CIMT regression in the AG group. Changes in apoB and LDL-P demonstrated borderline correlations with CIMT regression (P=.07 and P=.09).


In diabetic adults with no previous cardiovascular events, treatment to current targets for lipids and systolic blood pressure reduces atherosclerosis progression and when more aggressive targets are met, atherosclerosis regresses. The aggressive targets for LDL-C and non-HDL-C appeared to be the main determinants of CIMT regression and were more predictive of this outcome than changes in LDL-P or apoB.

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