Nine-Year Effects of 3.7 Years of Intensive Glycemic Control on Cardiovascular Outcomes
| Autor: | Matthew C. Riddle, Hertzel C. Gerstein, Vivian Fonseca, Faramarz Ismail-Beigi, Jeffrey L. Probstfield, William T. Friedewald, J. Thomas Bigger, Saul Genuth, Stephen J. Giddings, John B. Buse, William C. Cushman, Nancy L. Geller, Daniel P. Beavers, Alain G. Bertoni, Richard H. Grimm, Ruth Kirby, Elizabeth R. Seaquist, Timothy E. Craven, Carlos R Lopez Jimenez, Irene Hramiak |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Blood Glucose
Male medicine.medical_specialty Endocrinology Diabetes and Metabolism 030209 endocrinology & metabolism 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Risk Factors Diabetes mellitus Internal Medicine Medicine Humans Hypoglycemic Agents Prospective Studies Glycemic Aged Proportional Hazards Models Advanced and Specialized Nursing business.industry Incidence Middle Aged medicine.disease Cardiovascular Disease and Diabetes Treatment Outcome Diabetes Mellitus Type 2 Cardiovascular Diseases Emergency medicine Female business Cardiovascular outcomes Follow-Up Studies |
| Zdroj: | Diabetes Care |
| ISSN: | 1935-5548 0149-5992 |
| Popis: | OBJECTIVE In the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, ∼4 years of intensive versus standard glycemic control in participants with type 2 diabetes and other cardiovascular risk factors had a neutral effect on the composite cardiovascular outcome, increased cardiovascular and total mortality, and reduced nonfatal myocardial infarction. Effects of the intervention during prolonged follow-up were analyzed. RESEARCH DESIGN AND METHODS All surviving ACCORD participants were invited to participate in the ACCORD Follow-on (ACCORDION) study, during which participants were treated according to their health care provider’s judgment. Cardiovascular and other health-related outcomes were prospectively collected and analyzed using an intention-to-treat approach according to the group to which participants were originally allocated. RESULTS A total of 8,601 people, representing 98% of those who did not suffer a primary outcome or death during the ACCORD trial, were monitored for a median of 8.8 years and a mean of 7.7 years from randomization. Intensive glucose lowering for a mean of 3.7 years had a neutral long-term effect on the primary composite outcome (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death), death from any cause, and an expanded composite outcome that included all-cause death. Moreover, the risk of cardiovascular mortality noted during the active phase (hazard ratio 1.49; 95% CI 1.19, 1.87; P < 0.0001) decreased (HR 1.20; 95% CI 1.03, 1.39; P = 0.02). CONCLUSIONS In high-risk people with type 2 diabetes monitored for 9 years, a mean of 3.7 years of intensive glycemic control had a neutral effect on death and nonfatal cardiovascular events but increased cardiovascular-related death. |
| Databáze: | OpenAIRE |
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