Post on 25-Feb-2016
description
ACCORD: Treatment Effect onAll-Cause Mortality
Patients with events
(%)
Time (years)
25
0
20
15
10
5
01 2 3 4 5 6
Standard therapy
Intensive therapyHR 1.22 (1.01-1.46)
P = 0.04
1.41%/yr
1.14%/yr
ACCORD Study Group. N Engl J Med 2008;358:2545–59.
VADT – Non Fatal CV Events
Hazard Ratio and CL
0.845 (0.704, 1.016) p=0.0725
Time to nonfatal outcome1.0
0.8
0.6
0.4
0.2
0.00 1 2 3 4 5 6 7
Follow-up time (years)
Prop
ortio
n fr
ee o
f non
fata
l out
com
e
VADT Study Group. N Engl J Med 2009; 360:129-139.
ADVANCE: Treatment Effect on Primary Macrovascular Outcome
CV death, MI stroke
Cumulative incidence (%)
Follow-up (months)
25
20
15
10
5
00 6 12 18 24 30 36 42 48 54 60 66
HR 0.94 (0.84-1.06)P = 0.32 Standard
control
Intensive control
ADVANCE Collaborative Group. N Engl J Med 2008;358:2560–72.
VADT: Effects of RecentSevere Hypoglycemia
• Predictor of CV death HR 4.04 p≤0.008
• Predictor of all cause mortalityStandard HR 5.89 p=0.001Intensive HR 1.28 p=0.68
VADT Study Group. N Engl J Med 2009; 360:129-139.
Lancet 373:1765-72, 2009
Baseline Characteristics of Participants and Study Design of Clinical Trials to Compare Intensive glucose-lowering versus Standard Treatment
Kay et al, Lancet 373:1765-72, 2009
Study Design of Clinical Trials to Compare Intensive glucose-lowering versus Standard Treatment
Kay et al, Lancet 373:1765-72, 2009
Event Rates of Cardiovascular Outcomes of Intensive-Lowering versus Standard Treatments
Kay et al, Lancet 373:1765-72, 2009
Probability of events of non-fatal myocardial infarction with intensive glucose-lowering vs. standard treatment
Ray et al, Lancet 2009; 373: 1765–72
Probability of events of coronary heart disease with intensive glucose-lowering vs. standard treatment
Probability of events of stroke with intensive glucose-lowering versus standard treatment
Ray et al, Lancet 2009; 373: 1765–72
Probability of events of all-cause mortality with intensive glucose-lowering versus standard treatment
Ray et al, Lancet 2009; 373: 1765–72
Annals Internal Medicine 2009; 151: 394-403
Pooled relative risk and risk differences (per 1000 patients over 5 years of treatment) estimates of nonfatal MI, fatal MI, nonfatal stroke, fatal stroke, and PAD
UKPDS 34
UKPDS 34
ACCORD
ADVANCE
VADT
Kelly et al, Ann Inter Med 2009; 151: 394-403
Pooled relative risk and risk differences (per 1000 patients over 5 years of treatment) estimates of nonfatal MI, fatal MI, nonfatal stroke, fatal stroke, and PAD
Kelly et al, Ann Inter Med 2009; 151: 394-403
Pooled relative risk and risk differences (per 1000 patients over 5 years of treatment) estimates of severe hypoglycemia
Kelly et al, Ann Inter Med 2009; 151: 394-403
Summary of Meta-Analysis• These 2 meta-analysis found that, compared with
conventional control, intensive glucose control reduce the risk for cardiovascular disease (mostly nonfatal myocardial infarction) but not for cardiovascular death or all-cause mortality, and increased risk for severe hypoglycemia.
• Early trials suggested possible decreased risk for death with intensive control, whereas some more recent trials suggested possible increased risk for death with more stringent control.