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ADVANCE trial

Action in Diabetes & Vascular Disease: preterAx & diamicroN-MR Controlled Evaluation (ADVANCE) study , Study characteristics: - 11,140 adults with type 2 diabetes at high risk for cardiovascular disease - ~7.6% had atrial fibrillation at baseline , Study design: - randomized to either perindopril plus indapamide or placebo - treatment to intensively lower blood glucose below 6.5% or standard treatment , Results: 1) no difference in mortality with tight glycemic control; reasons for this are unclear 2) at 4 years, patients with atrial fibrillation were at greater risk for all-cause mortality (hazard ratio, 1.6), heart failure (HR, 1.7), cerebrovascular events (HR, 1.7), & cardiovascular death (HR, 1.8), relative to those without atrial fibrillation 3) blood pressure treatment reduced risk for cardiovascular mortality (RR=0.88) & all-cause mortality (RR=0.91) both among patients with & without atrial fibrillation [3] 4) patients with atrial fibrillation, compared with hypertensive patients without atrial fibrillation, saw greater absolute benefits from blood pressure therapy; the number needed to treat for 5 years to prevent one death was 42 among patients with atrial fibrillation & 120 among those without atrial fibrillation

Related

Action to Control Cardiovascular Risk in Diabetes (ACCORD trial) diabetes mellitus type 2 (insulin-resistant)

General

clinical trial

References

  1. Canadian Diabetes Assocatiation http://www.diabetes.ca/section_main/newsreleases.asp?ID=210
  2. Du X et al, Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation: results of the ADVANCE study European Heart Journal, doi:10.1093/eurheartj/ehp055 published online on March 11, 2009 PMID: 19282274
  3. Zoungas S et al Follow-up of Blood-Pressure Lowering and Glucose Control in Type 2 Diabetes. N Engl J Med. September 19, 2014 PMID: 25234206