CAT ASCOT Atenolol and NOD

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My First Practice-Altering CAT. And I'm not even in practice yet!

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CAT ASCOT Atenolol and NOD

  1. 1. CAT: Atenolol and New-Onset Diabetes Mellitus Clinton Pong IM Journal Club 4/2/09
  2. 2. My Clinical Question <ul><li>“ Is Atenolol associated with new-onset diabetes mellitus (NOD) in patients with significant cardiovascular risk factors? </li></ul><ul><li>“ CV RF” </li></ul><ul><ul><li>55+ y/o </li></ul></ul><ul><ul><li>Male </li></ul></ul><ul><ul><li>smoker </li></ul></ul><ul><ul><li>LVH </li></ul></ul><ul><ul><li>EKG abnormalities </li></ul></ul><ul><ul><li>DM II </li></ul></ul><ul><ul><li>PAD </li></ul></ul><ul><ul><li>PMH Stroke/TIA </li></ul></ul><ul><ul><li>Microalbuminuria/proteinuria </li></ul></ul><ul><ul><li>Tchol:HDL >6 </li></ul></ul><ul><ul><li>FHx of premature CHD </li></ul></ul>
  3. 3. Search
  4. 4. Source ASCOT Trial: CCB (Amlodipine) vs BB (Atenolol)
  5. 5. Validity? <ul><li>Randomized </li></ul><ul><li>Accountable </li></ul><ul><li>Intention to treat analysis </li></ul><ul><li>Similar groups </li></ul><ul><li>Sponsored by Pfizer, Servier, and Leo Pharmaceuticals </li></ul>
  6. 6. Population Goal: 18,000 Recruited:19,257 Final study pop: 18,965 Intervention Comparison Amlodipine Atenolol + Perindopril + Bendroflumethiazide (n=9639) (n=9618)
  7. 7. 567 799 9072 8819 CV endpoints NOD 5.5 years Amlodipine Atenolol NOD (+) No NOD
  8. 8. Results <ul><li>total cardiovascular events and procedures </li></ul><ul><li>Kaplan-Meier curves of cumulative incidence of new-onset diabetes mellitus </li></ul>NNH: 40 NNH: 42
  9. 9. Care of my patient <ul><li>Atenolol’s effectiveness in the prevention of CV disease has been called into question by numerous other studies </li></ul><ul><li>No long-term comparative effectiveness studies compare it to other beta blockers </li></ul><ul><li>Regarded as an “atypical beta blocker” </li></ul>
  10. 10. Summary statement: <ul><li>I do believe that the results suggest that Atenolol is an inferior choice for the initial treatment of HTN in the prevention of CV disease and new-onset diabetes compared to Amlodipine and I recommend that our patients switch to this drug today. </li></ul>
  11. 11. Resources <ul><li>Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. </li></ul><ul><ul><li>Dahlöf B, et al. Lancet. 2005 Sep 10-16;366(9489):895-906. </li></ul></ul><ul><li>The Anglo-Scandinavian Cardiac Outcomes Trial-- blood pressure lowering arm. (ASCOT) </li></ul><ul><ul><li>J Clin Pharm Ther. 2006 Aug;31(4):299-307 </li></ul></ul>

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