Page 297 - TNFlipTest

Toronto Notes 2019 Landmark Endocrinology Trials Endocrinology E55 Landmark Endocrinology Trials
Trial
DIABETES
ACCORD ADVANCE
BARI-2D
DCCT
EDIC
Look AHEAD NAVIGATOR PREDIMED Steno-2
UKPDS
UKPDS Extension
VADT
LIPIDS
4S FIELD HPS Jupiter TNT
Reference
NEJM 2008;358:2560-72 NEJM 2008;358:2545-59
NEJM 2009;360:2503-15 NEJM 1993;329:977-86
NEJM 2005;353:2644-53 NEJM 2013;369:145-54 NEJM 2010;362:1463-90 NEJM 2013;368:1279-90 NEJM 2008;358:580-91
Lancet 1998;352:837-53 NEJM 2008;359:1577-89
NEJM 2009;360:1-11
Lancet 1994;344:1383-89
Lancet 2005;366:1849-61
Lancet 2002;360:7-22
NEJM 2008;359:2195- 207
NEJM 2005;352:1425-35
Results
Compared with standard therapy the use of intensive therapy to target normal HbA1c levels (<6%) for 3.5 yr increased mortality and did not significantly reduce major cardiovascular events
Intensive glucose control that lowered the HbA1c value to 6.5% and reduced the incidence of nephropathy but did not significantly reduce major macrovascular events, death from cardiovascular events, or death from any cause; hypoglycemia was more common in the intensive control group
In patients with both Type 2 DM and CAD, no significant difference was found in the rates of death and major cardiovascular events in patients undergoing prompt revascularization and those undergoing medical therapy or between strategies of insulin sensitization and insulin
Intensive blood glucose control delayed the onset and reduced the progression of microvascular complications (retinopathy, nephropathy, and neuropathy) in Type 1 DM
Compared with conventional therapy, intensive DM therapy early on without macrovascular disease (goal HbA1c <6.05%) has long- term beneficial effects on the risk of cardiovascular disease in patients with Type 1 DM
Moderate weight loss (<7% BW) and increased exercise are not associated with reduction in CVD and its complications among overweight or obese patients with Type 2 DM
In patients with impaired glucose tolerance, nateglinide did not reduce progression to DM or risk of cardiovascular events while valsartan only reduced progression to DM
A Mediterranean diet with extra-virgin olive oil or nuts reduces rates of MI, CVA, or CV death in those at high risk for CV disease (outcome was driven by reduction in rates of CVA)
In at-risk patients with Type 2 DM, intensive intervention with multiple drug combinations and behaviour modification had sustained significant beneficial effects with respect to vascular complications and mortality; multifactorial intervention is critical in the management of Type 2 DM
Intensive blood glucose control reduces microvascular but not macrovascular complications in Type 2 DM
Continued risk reduction in microvascular risk and emergent risk reductions for MI and death from any cause 10 yr post UKPDS trial follow-up in Type 2 DM
In patients with longstanding poorly controlled Type 2 DM, intensive glucose control had no significant effect on the rates of major cardiovascular events, death, or microvascular complications; adverse events, predominantly hypoglycemia, were more common in the intensive control group
In patients with angina or previous MI and high total cholesterol, simvastatin reduced: all-cause mortality, fatal and nonfatal coronary events, and need for coronary artery bypass surgery or angioplasty
In patients with Type 2 DM not previously on statin therapy, fenofibrate did not significantly reduce the risk of the primary outcome of coronary events; it did reduce non-fatal MI and revascularizations
In high-risk patients with various cholesterol values, simvastatin reduced all-cause mortality, coronary deaths, and major vascular events
Rosuvastatin significantly reduced the incidence of major cardiovascular events in patients with elevated high-sensitivity CRP levels and no hyperlipidemia
Lipid-lowering therapy with atorvastatin 80 mg/d in patients with stable CHD provides clinical benefit beyond atorvastatin 10 mg/d