29 A pragmatic, cluster randomised study undertaken in primary care, ADDITION-Europe, was unable to detect cardiovascular benefit of multifactorial therapy compared with routine care in people with type 2 diabetes detected by screening.
A 5.5-year extension of that same study demonstrated that the multifactorial therapy was associated with sustained lower risk of cardiovascular events or death (20).
He noted that the DIAD study suggests it is not necessary to screen for silent myocardial ischemia and that multifactorial therapy was appropriate, with evaluation if symptoms occur.
The Arterial Disease Multiple Intervention Trial (ADMIT) was designed to determine the efficacy, safety, and compliance of an multifactorial therapy on selected atherosclerotic disease risk factors in patients with PAD.
Multifactorial therapy (lipid normalization, tight control of hypertension, near-normal glucose control, anti-platelet therapy) is cost-effective in preventing complications in patients with diabetes and cardiovascular disease.
Also, potential interactions with the frequent use of aspirin and other antiplatelet drugs in the context of multifactorial therapy, i.e. the gold standard therapy to manage total CV risk in patients with type 2 diabetes, might be worth studying.
Lastly, the Steno-2 trial compared the effect of a multifactorial intensive therapy (n = 80) with that of conventional treatment (n = 80) on modifiable risk factors for cardiovascular disease in patients with Type 2 diabetes [ 55].
With a multifactorial etiology, therapy that focuses on one facet has limited therapeutic efficacy [ 6, 7].
Finally a multifactorial group was designed including patients with multiple AKI risk factors such as dehydration, contrast administration, and nonsteroidal anti-inflammatory therapy with AKI (case group) or normal renal function (control group).
