Relationship of Glycemia to Cardiovascular Disease ... - Lipids Online

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Glycemic Control and Macrovascular Disease in Patients With Type 1 or Type 2 Diabetes: Meta-analysis analysis of Clinical Trials Trials Holman Verrillo Lauritzen Feldt- Rasmussen DCCT PP DCCT SI SDIS MCSG Overall Trials in Type 1 Diabetes Favors Intensified Glycemic Control Favors Conventional Glycemic Control 0.01 0.1 .5 1 2 10 100 Incidence Rate Ratio % Weight 1.5 6.6 1.5 1.7 35.4 44.0 7.8 1.5 100.0 Reprinted from Stettler C, et al. Am Heart J. 2006; 152:27–38, with permission from Elsevier. Trials in Type 2 Diabetes Favors Favors Intensified Conventional Glycemic Glycemic Trials Control Control Veterans Affairs UKPDS 1 UKPDS 2 UKPDS 3 Kumamoto PP Kumamoto SI Overall 0.01 0.1 0.5 1 2 10 100 Incidence Rate Ratio % Weight 4.3 53.6 27.2 14.3 0.1 0.5 100.0 Slide Source Lipids Online Slide Library www.lipidsonline.org Glycemic Control and Macrovascular Disease in Patients With Type 1 or Type 2 Diabetes: Meta-analysis of Clinical Trials Stettler et al. (2006) evaluated those trials in which pharmacologic treatment of hyperglycemia in patients with type 2 diabetes was evaluated with respect to macrovascular disease. They found that, at best, intensified glycemic control was associated with only a modest reduction in macrovascular disease. Although these data are promising, none of the trials that were evaluated showed the degree of dramatic reduction that one might expect based on the epidemiological correlation between the level of glycemia and cardiovascular risk. Reference: Stettler C, Allemann S, Jüni P, et al. Glycemic control and macrovascular disease in types 1 and 2 diabetes mellitus: meta-analysis of randomized trials. Am Heart J. 2006;152:27- 38. Source: Lipids Online Slide Library (www.lipidsonline.org) Page 10 of 36 © 2009 Baylor College of Medicine, Houston, Texas
DCCT-EDIC: Long-term Risk of Macrovascular Complications Hemoglobin A 1C 12% 10% 8% 6% Conventional Intensive P < 0.001 P < 0.001 P = 0.61 Cumulative Incidence 0.12 0.10 0.08 0.06 0.04 0.02 Any Cardiovascular Outcome 42% risk reduction P = 0.02 Conventional Intensive DCCT End of Randomized Treatment EDIC Year 1 EDIC Year 7 0.00 0 2 4 6 8 10 12 14 16 18 20 Years Since Entry* *Diabetes Control and Complications Trial (DCCT) ended and Epidemiology of Diabetes Interventions and Complications (EDIC) began in year 10 (1993). Mean follow-up: 17 years. DCCT/EDIC Research Group. JAMA. 2002;287:2563-2569. Copyright © 2002 American Medical Association. All rights reserved. | Nathan DM, et al. N Engl J Med. 2005;353:2643-2653. Copyright © 2005 Massachusetts Medical Society. All rights reserved. Slide Source Lipids Online Slide Library www.lipidsonline.org DCCT-EDIC: Long-term Risk of Macrovascular Complications At the end of the randomized treatment phase in the Diabetes Control and Complications Trial, the research group found a difference in the concentration of hemoglobin A 1c between the patients with type 1 diabetes in the intensive treatment group and those in the conventional treatment group. At the end of the trial, there was a nonsignificant reduction in cardiovascular outcome in the intensively treated group. The trial ended at approximately 9 years; afterward, there was convergence of treatments and similar levels of glycemic control were achieved. There was persistent benefit, however, among the intensively treated group such that there was a statistically significant reduction in cardiovascular disease when compared to the conventionally treated group in the followup phase (up to 20 years) of the study. These data would indicate that 10 years of intensive treatment yielded a cardiovascular benefit during the first 10 years that was sustained and became greater in the follow-up phase. References: Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA. 2002;287:2563-2569. Nathan DM, Cleary PA, Backlund JY, et al, for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353:2643-2653. Source: Lipids Online Slide Library (www.lipidsonline.org) Page 11 of 36 © 2009 Baylor College of Medicine, Houston, Texas
Page 1 and 2: Relationship of Glycemia to Cardiov
Page 3 and 4: TNT Study: Impact of Glucometabolic
Page 5 and 6: The Proinflammatory Milieu in Ather
Page 7 and 8: STOP-NIDDM Trial: Acarbose Prevents
Page 9: Controlling Postprandial Hyperglyce
Page 13 and 14: Non-UKPDS Trials: Metformin vs. Oth
Page 15 and 16: Balance of Evidence: Is Rosiglitazo
Page 17 and 18: PROactive: Difference in Number of
Page 19 and 20: Factors Possibly Contributing to th
Page 21 and 22: Annual Incidence of Congestive Hear
Page 23 and 24: ORIGIN = Outcome Reduction with Ini
Page 25 and 26: PERISCOPE: Study Design IVUS at Scr
Page 27 and 28: PERISCOPE: Intravascular Ultrasound
Page 29 and 30: APPROACH: Using Intravascular Ultra
Page 31 and 32: STENO-2: Reduction in Cardiovascula
Page 33 and 34: STENO-2: Risk-Factor Targets Attain
Page 35 and 36: SANDS Randomized Trial: Effects of

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