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Showing papers by "Bastiaan E. de Galan published in 2009"


Journal ArticleDOI
TL;DR: Atrial fibrillation is relatively common in type 1 diabetes and is associated with substantially increased risks of death and cardiovascular events in patients with type 2 diabetes, and this arrhythmia identifies individuals who are likely to obtain greater absolute benefits from blood pressure-lowering treatment.
Abstract: AIMS: The aim of this study was to investigate serious clinical outcomes associated with atrial fibrillation (AF) and the effects of routine blood pressure lowering on such outcomes in the presence or absence of AF, among individuals with type 2 diabetes. METHODS AND RESULTS: About 11 140 patients with type 2 diabetes (7.6% of whom had AF at baseline) were randomized to a fixed combination of perindopril and indapamide or placebo in the Action in Diabetes and Vascular Disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study. We compared total mortality and cardiovascular disease outcomes and effects of randomized treatment for 4.3 years on such outcomes between patients with and without AF at baseline. After multiple adjustments, AF was associated with a 61% (95% confidence interval 31-96, P < 0.0001) greater risk of all-cause mortality and comparable higher risks of cardiovascular death, stroke, and heart failure (all P < 0.001). Routine treatment with a fixed combination of perindopril and indapamide produced similar relative, but greater absolute, risk reductions for all-cause and cardiovascular mortalities in patients with AF, compared with those without AF. The number of patients needed to be treated with perindopril-indapamide for 5 years to prevent one cardiovascular death was 42 for patients with AF and 120 for patients without AF at baseline. CONCLUSION: Atrial fibrillation is relatively common in type 2 diabetes and is associated with substantially increased risks of death and cardiovascular events in patients with type 2 diabetes. This arrhythmia identifies individuals who are likely to obtain greater absolute benefits from blood pressure-lowering treatment. Atrial fibrillation in diabetic patients should be regarded as a marker of particularly adverse outcome and prompt aggressive management of all risk factors.

187 citations


Journal ArticleDOI
TL;DR: Recent clinical trial data have cemented the crucial role of BP-lowering and statin treatment for the prevention of cardiovascular events in patients with diabetes, but the uncertainty about intensive glucose control for these outcomes remains.
Abstract: PURPOSE OF REVIEW: To provide an overview of recent clinical trial findings relevant to cardiovascular risk management in patients with diabetes RECENT FINDINGS: Recent trial evidence has demonstrated benefits of routine blood pressure (BP) lowering, regardless of initial BP levels, in people with type 2 diabetes In addition, new data indicate that any BP-lowering strategy in diabetic patients needs to be continued to realise sustained benefits The effects of blood glucose lowering have been addressed in a number of recently concluded clinical trials; together, these have failed to provide clear evidence of cardioprotection with intensive glucose control over a 4-5-year period Long-term data, however, suggest that such benefits may only appear later A recent meta-analysis of statin trials has confirmed the benefits of these agents in patients with diabetes Two new trials of aspirin for 'primary prevention' of cardiovascular events in diabetic patients have failed to show benefit; however, both were underpowered SUMMARY: Recent clinical trial data have cemented the crucial role of BP-lowering and statin treatment for the prevention of cardiovascular events in patients with diabetes, but the uncertainty about intensive glucose control for these outcomes remains New evidence relating to other lipid-modifying agents and routine antiplatelet therapy in diabetes is anticipated over the next few years

7 citations


Journal ArticleDOI
TL;DR: Intensive glucose control was not associated with a significant reduction in macrovascular events; however, unlike reports from the recently reported Action to Control Cardiovascular Risk in Diabetes (ACCORD), there was no evidence of any increase in all-cause mortality or cardiovascular death with more intensive glucose control.
Abstract: The Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial investigated the effects of routine blood pressure lowering and intensive blood glucose control on major vascular events in people with Type 2 diabetes. In this factorial randomized study, 11,140 individuals with Type 2 diabetes were randomly assigned to a fixed combination of perindopril and indapamide or matching placebo, and to intensive glucose control with the use of modified-release gliclazide plus other drugs required to achieve a hemoglobin A1c of 6.5% of less, or standard guideline-based glucose control. The primary outcomes were composites of major macrovascular and major microvascular events (major vascular events), analyzed jointly and separately. Active treatment in the blood pressure-lowering arm reduced blood pressure by 5.6/2.2 mmHg compared with placebo, and the relative risks of major vascular events, all deaths and cardiovascular deaths by 9% (p = 0.043), 14% (p = 0.025) and 18% (p = 0.027), respectively. These effects appeared independent of the initial blood pressure level or the use of concomitant treatments. Intensive glucose control lowered glycated hemoglobin levels to a mean of 6.5% and reduced the relative risk of major vascular events by 10% (p = 0.01), primarily through a 21% (p = 0.006) reduction in nephropathy. Intensive glucose control was not associated with a significant reduction in macrovascular events; however, unlike reports from the recently reported Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, there was no evidence of any increase in all-cause mortality or cardiovascular death with more intensive glucose control. This trial has provided important new evidence with direct implications for clinical management of blood pressure and blood glucose in patients with Type 2 diabetes.

2 citations