There are limited data to determine whether the imple- mentation of lifestyle modification in at-risk patients can translate into a reduced risk of HF. The Steno-2 study307 (Intensified Multifactorial Intervention in Patients With Type 2 Diabetes and Microalbuminuria) reported a reduced risk of CVD in patients with type 2 diabetes mellitus who par- ticipated in an intensive, multifactorial intervention that in- cluded quarterly clinic visits; a low-fat diet; 30 minutes of exercise 3 to 5 times/wk; prescription of an ACE inhibitor, a multivitamin, and aspirin; and a step-wise approach to pharmacological therapy for diabetes mellitus, hyperten- sion, and hyperlipidemia. After a mean follow-up of 7.8 years, the intensive therapy group experienced a signifi- cant risk reduction in a combined end point that included cardiovascular mortality, nonfatal MI, coronary artery by- pass surgery, percutaneous coronary intervention, nonfa- tal stroke, amputation, or vascular surgery for peripheral P=0.008). Because the Steno-2 trial used an aggressive lifestyle and pharmacological approach to improving the metabolic risk factors, the study could not assess the contributions of the individual treatment components and specific reduction in HF. In the Look-AHEAD trial (Action in Health in Diabetes), intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes Participants (n=5145) were randomized to conventional therapy or an intensive lifestyle modification program that included a hypocaloric, low-fat diet; use of Table 12. 