SANDS

Stop   Atherosclerosis in         N ative        Diabetics          Study Directory Committees Training Materials Tools Forms       Although once protected from cardiovascular disease (CVD), American Indians now have incidence rates higher than the general US population . The majority of CVD cases occur in individuals with diabetes. It is therefore imperative that intervention strategies to reduce CVD in individuals with diabetes be developed and validated in this population. The aim of SANDS is to prove the effectiveness of a strategy of lowering LDL cholesterol and blood pressure to lower targets than are currently recommended. This study will be a randomized 3-year trial to examine the effects on CVD of intensive LDL reduction (goal <= 70 mg/dL) and intensive blood pressure lowering (goal <= 115/75 mmHg), compared to usual targets of <= 100 mg/dL and <= 130/85 mmHg. These cutpoints were chosen because mean LDL and blood pressure levels are lower in this population, but there are strong relations between LDL, blood pressure, and CVD at levels below current targets. The study will enroll 548 diabetic American Indian men and women > 40 years of age and will be conducted in four field centers involving Indian Health Service/Tribal primary care facilities in Phoenix/Sacaton, Arizona; Chinle, Arizona; Rapid City/Pine Ridge, South Dakota; and Lawton, Oklahoma, with input from American Indian physicians and community members. Reports of findings will be sent to both participants and providers. Participants will also be provided health education. There are numerous advantages to the SANDS study design. First, it doesn't require large numbers of participants. Second, there will only be three years of follow-up. Third, only FDA approved drugs will be used. Finally, endpoint tests of cardiovascular disease are safe and painless. Study results will provide evidence needed to develop community-based programs to treat and prevent the epidemic of CVD among American Indians. The data will also be valuable in understanding the effects of intensive risk-factor reduction on atherosclerosis burden and cardiac function in diabetic individuals in all US populations and provide evidence for determining LDL and blood pressure treatment goals for diabetic patients.