Hội Tim mạch học Việt Nam New in Diabetes

Mayo Clinic Outpatient Center CVD Risk Factor Management in Diabetic Patients: What's New in 2010? Thomas G Allison, PhD, MPH Cardiovascular Diseases and Internal Medicine Mayo Clinic Rochester, MN • Disclosures: none • Off-label use of drugs: none The ACCORD Trial The trial with arms but no legs to stand on ACCORD Double x Factorial Design Lipid BP Placebo Fibrate Intensive Intensive Glycemic Control 1383 1374 1178 1193 5128 Standard Glycemic Control 1370 1391 1184 1178 5123 2765 2362 2371 10,251 2753 5518 Standard 4733* * 94% power for 20% reduction in event rate, assuming standard group rate of 4% / yr and 5.6 yrs follow-up ACCORD Baseline Patient Characteristics Number of patients: 10,251 Age: 62 years Duration of diabetes: 10 years Macrovascular disease: >35 % HbA1c: 8.1% ACCORD-Glucose Treatment Approach HbA1c Target: < 6.0% versus < 7.0-7.9% Duration of follow-up: Median 3.4 yrs Ending therapy: Sulfonylurea: 78% vs 68% Repaglinide: 50% vs 18% Metformin: 74% vs 67% Rosiglitazone: 91% vs 58% Exenatide: 12% vs 4% Insulin: 77% vs 35% ACCORD Glucose control 9.0 Hba1c (%) 8.5 Standard therapy 8.0 7.5 7.0 6.5 6.0 Intensive therapy Time (years) ACCORD Study Group N Engl J Med.008;358:2545-59 ACCORD Primary outcome (CV death, MI, stroke) Patients with events (%) 25 20 Standard therapy HR 0.90 (0.78-1.04) P = 0.16 15 10 Intensive therapy 0 Time (years) ACCORD Study Group N Engl J Med.008;358:2545-59 ACCORD All-cause mortality 25 20 Patients with events (%) 15 Intensive therapy HR 1.22 (1.01-1.46) P = 0.04 10 Standard therapy 0 Time (years) ACCORD Study Group N Engl J Med.008;358:2545-59 • Intensive Intervention: – 2-drug therapy initiated: thiazide-type diuretic + ACEI, ARB, or -blocker – Drugs added and/or titrated at each visit to achieve SBP