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

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Clinical Trials Will (or Should) Answer Important Questions About Type 2 Diabetes Mellitus and Cardiovascular Risk Question 1: Does treatment-directed lowering of HbA 1c 1c reduce the risk of cardiovascular disease? • ACCORD • ADVANCE • VADT • ORIGIN Question 2: Does it matter which diabetes treatment is used to achieve a lower HbA 1c 1c concentration? • PERISCOPE • APPROACH • BARI-2D • RECORD • VICTORY HbA 1c = hemoglobin A 1c Slide Source Lipids Online Slide Library www.lipidsonline.org Clinical Trials Will (or Should) Answer Important Questions About Type 2 Diabetes Mellitus and Cardiovascular Risk There are two major questions regarding type 2 diabetes and cardiovascular risk. First, does treatment-directed lowering of the hemoglobin A 1c concentration reduce the risk of cardiovascular disease? We have received some answers to this question from the findings of the recent ACCORD, ADVANCE, and VADT studies. The ORIGIN trial is underway and is evaluating whether giving insulin to patients with prediabetes or newonset diabetes can reduce cardiovascular disease. Second, does it matter which diabetes treatment is used to achieve a lower concentration of hemoglobin A 1c ? The PERIOSCOPE and APPROACH trials each looked at the progression of atherosclerosis by using intracoronary ultrasound to compare the effects of treatment with thiazolidinediones or sulfonylureas. The BARI-2D trial is evaluating whether an insulin-sensitizing approach is better than an insulin-providing approach in reducing cardiovascular events in patients with type 2 diabetes and coronary artery disease. The RECORD trial is comparing rosiglitazone to sulfonylureas and metformin with regard to cardiovascular endpoints, and the VICTORY trial is examining the progression of disease in saphenous vein grafts in diabetic patients who were randomized to receive rosiglitazone or placebo. ACCORD = Action to Control Cardiovascular Risk in Diabetes ADVANCE = Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation APPROACH = Assessment on the Prevention of Progression by Rosiglitazone on Atherosclerosis in diabetes patients with Cardiovascular History BARI-2D = Bypass Angioplasty Revascularization Investigations 2 Diabetes Source: Lipids Online Slide Library (www.lipidsonline.org) Page 22 of 36 © 2009 Baylor College of Medicine, Houston, Texas
ORIGIN = Outcome Reduction with Initial Glargine Intervention PERISCOPE = Pioglitazone Effect on Regression of Intravascular Sonographic Coronary Obstruction Prospective Evaluation RECORD = Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes VADT = Veterans Affairs Diabetes Trial VICTORY = Vein-Coronary Atherosclerosis and Rosiglitazone After Bypass Surgery ACCORD: Deaths in Intensive vs. Standard Glycemic Control Groups: Preliminary Results Deaths, n Rate per 1,000 patients/year Standard Glycemic Control (Hemoglobin A 1c 7.0–7.9%) 203 11 Intensive Glycemic Control (Hemoglobin A 1c ,
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Page 25 and 26: PERISCOPE: Study Design IVUS at Scr
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Relationship of Glycemia to Cardiovascular Disease ... - Lipids Online

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