1) The document summarizes the results of a large clinical trial testing the fixed-dose combination drug Preterax (perindopril and indapamide) for the treatment of type 2 diabetes patients.
2) The trial found that Preterax reduced the risk of cardiovascular mortality by 18%, total mortality by 14%, and the combined outcome of major macrovascular or microvascular events by 9% compared to placebo.
3) The beneficial effects of Preterax were consistent across patient subgroups and backgrounds in ancillary treatments.
http://www.theheart.org/web_slides/1135309.do
A study on Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients (ADVANCE)
Effects of Sodium Glucose contransporter (SGLT2) inhibition on renal outcomes in patients with (diabetic) chronic kidney disease.
Presentation given during the East by Southwest, Annual Update in Nephrology, September 17th 2017, Santa Fe, NM
http://medicine.unm.edu/academic-divisions/nephrology/east-by-southwest.html
Presentation given to our fellowship program about diabetic kidney disease.
2022 update discussing SGLT2i, MRA (e.g. finerenone), health economics and beyond
http://www.theheart.org/web_slides/1135309.do
A study on Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients (ADVANCE)
Effects of Sodium Glucose contransporter (SGLT2) inhibition on renal outcomes in patients with (diabetic) chronic kidney disease.
Presentation given during the East by Southwest, Annual Update in Nephrology, September 17th 2017, Santa Fe, NM
http://medicine.unm.edu/academic-divisions/nephrology/east-by-southwest.html
Presentation given to our fellowship program about diabetic kidney disease.
2022 update discussing SGLT2i, MRA (e.g. finerenone), health economics and beyond
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Management of CAD in Diabetes the cardiovascular equivalent is challenging.The slides take you from the epidemiology,ADD,and CV benefit and how to manage CAD
New Therapeutics in Diabetic Kidney Disease
Conjoint Meeting of the Iraqi Society of Nephrology and Renal Transplantation and The Iraqi Diabetes Association.
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
Cardiovascular safety of anti-diabetic drugs.Cardiovascular Outcome Trials ...magdy elmasry
Cardiologists and diabetes.Target organs and action mechanism of antidiabetic drugs.Cardiovascular Outcome Trials
( CVOTs ) in Diabetes.Completed and ongoing CVOTs in type 2 diabetes.Diabetes Medications
and
Cardiovascular Impact.Recommendations for management of diabetes
Cardiovascular safety of anti-diabetic drugs.
Imeglimin, What is new?
By Dr. Usama Ragab Youssif
Lecturer of Medicine - Zagazig University
Agenda
Mitochondrial function and dysfunction
Mitochondrial (dys)function in diabetes
Diabetes core defects and Imeglimin
Imeglimin drug development and approval
Imeglimin and Heart
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Management of CAD in Diabetes the cardiovascular equivalent is challenging.The slides take you from the epidemiology,ADD,and CV benefit and how to manage CAD
New Therapeutics in Diabetic Kidney Disease
Conjoint Meeting of the Iraqi Society of Nephrology and Renal Transplantation and The Iraqi Diabetes Association.
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
Cardiovascular safety of anti-diabetic drugs.Cardiovascular Outcome Trials ...magdy elmasry
Cardiologists and diabetes.Target organs and action mechanism of antidiabetic drugs.Cardiovascular Outcome Trials
( CVOTs ) in Diabetes.Completed and ongoing CVOTs in type 2 diabetes.Diabetes Medications
and
Cardiovascular Impact.Recommendations for management of diabetes
Cardiovascular safety of anti-diabetic drugs.
Imeglimin, What is new?
By Dr. Usama Ragab Youssif
Lecturer of Medicine - Zagazig University
Agenda
Mitochondrial function and dysfunction
Mitochondrial (dys)function in diabetes
Diabetes core defects and Imeglimin
Imeglimin drug development and approval
Imeglimin and Heart
Coversyl Plus and Coversyl Plus HD is Potent ACE Inhibitor of class drugs with Cardiovascular and stroke Protection with significant Mortality & Morbidity reduction in wide class of Patients with Newly Diagnosed Hypertension Patients,CAD Patients,Patients with H/O stroke/TIA ,hypertensive Diabetic Patients and CKD Patients
http://www.theheart.org/web_slides/1283563.do
A study on Anglo-Scandinavian Cardiac Outcomes--Lipid Lowering Arm (ASCOT-LLA) designed to assess the effect on risk of normal MI and fatal CHD of two treatment strategies.
2nd CUTEHeart Workshop Manuel Gomes PresentationLBNicolau
Manuel Gomes from the London School of Hygiene and Tropical Medicine, UK gave valuable insights on "Non-compliance in randomised controlled trials comparing vascular and endovascular interventions for cardiovascular care" at the 2nd CUTEHeart Workshop in CPC2016.
Dyslipidemia management an evidence based approachDr Vivek Baliga
In this presentation by Dr Vivek Baliga, he discusses the different available statins and how you can choose the right one in different clinical situations. See articles from Dr Baliga on http://drvivekbaliga.net
Dyslipidemia management an evidence based approachDr Vivek Baliga
How is dyslipidemia managed in clinical practice? Here is a short review on how current guidelines are shaping clinical practice, and how saroglitazar is playing a role in it.
Un nuevo horizonte en el tratamiento de las dislipemias
14/09/15 18:00h-19:30h Casa del Corazón (Madrid)
http://objetivoLDL.secardiologia.es
#objetivoLDL
Abordaje terapéutico de la dislipemia en el paciente con enfermedad renal crónica
Dr. Jesús Egido de los Ríos, Jefe Servicio Nefrología e Hipertensión Fundación Jiménez Díaz (Madrid)
Atorvastatin: Statins in CVD management. Is just lipid lowering enough Dr Vivek Baliga
When it comes to management of cardiovascular diseases, are achieving lipid lowering targets sufficient. Here Dr Vivek Baliga, Consultant Internal medicine discusses the additional benefits of statins in CVD in India.
Diabetes and acute coronary syndrome
Diabetic patients as compared to non diabetics withacute cornary syndrome (ACS) at 2 years showed a
1.8 fold increase in cardiovascular deaths
1.4 fold increase in myocardial infarctions (MI)
www.srisriholistichospitals.com
Management of coronary disease in diabetes - Is it different?Dr Vivek Baliga
The management of diabetes and coronary artery disease go hand in hand. This presentation by Dr Vivek talks on whether it varies from usual management.
Mubashar A Choudry MD | Effects of statin or usual care on outcomesMubashar A Choudry MD
Here, Dr. Mubashar A Choudry MD is explaining about effects of statin or usual care on outcomes. Dr. Mubashar Choudry is a respected cardiologist in Washington.
Conducting an Efficient Literature Search revised.pptxRodolfo Rafael
Literature search is a critical component for any evidence-based project. It helps you to understand the complexity of a clinical issue, gives you insight into the scope of a problem, and provides you with best treatment approaches and the best available evidence on the topic.
Computers in medical education dr. rodolfo rafaelRodolfo Rafael
The goals of medical education are to provide students and graduate clinicians specific facts and information, to teach strategies for applying this knowledge appropriately to the situations that arise in medical practice, and to encourage the development of skills necessary to acquire new knowledge over a lifetime of practice. Students must learn about physiological processes and must understand the relationships between their observations and these underlying processes. They must learn to perform medical procedures, and they must understand the effects of different interventions on health outcomes. Also, the student must learn “softer” skills and knowledge, such as interpersonal and interviewing skills and the ethics of medical care. Medical school faculty employs a variety of strategies for teaching, ranging from the one-way, lecture-based transmission of information to the interactive, Socratic method of instruction. In general, we can view the teaching process as the presentation of a situation or a body of facts that contains the essential knowledge that students should learn; the explanations of what the important concepts and
relationships are, how they can be derived, and why they are important; and the strategy for guiding interaction with a patient.
Female reproductive functions can be divided into two major phases:
preparation of the female body for conception and pregnancy and
(2) the period of pregnancy itself.
This lecture is concerned with preparation of the female body for pregnancy, and presents the physiology of pregnancy and childbirth
Growth of the fetus begins soon after fertilization, when the first cell division occurs.
Cell division, hypertrophy, and differentiation are highly coordinated events that result in the growth and development of specialized organ systems.
The fetus, fetal membranes, and placenta develop and function as a unit throughout pregnancy, and their development is interdependent or symbiotic.
The growth trajectory of fetal mass is relatively flat during the first trimester, increases linearly at the beginning of the second trimester, and rises rapidly during the third trimester.
Asthma is a serious public health problem throughout the world, affecting people of all ages. When uncontrolled, asthma can place severe limits on daily life, and is sometimes fatal.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
3. Global projections for diabetes (millions) 2007-2025 World 2007 = 246 million 2025 = 380 million Increase +55% Diabetes Atlas , 3rd edition, IDF 2006 28.3 40.5 +43% 16.2 32.7 +102% 10.4 18.7 +80% 53.2 64.1 +21% 24.5 44.5 +81% 67.0 99.4 +48% 46.5 80.3 +73%
4. Proportion of Treated Diabetic Patients with Controlled and Uncontrolled Blood Pressure Mancia G et al., J Hypertens 2005; 23: 1575-1581 < 130/80 3.0% n = 2491 BP is uncontrolled in most diabetics > 140/90 85.1% < 140/90 14.9%
5.
6. “ Current guidelines recommend the lowering of blood pressure for people with type 2 diabetes to reduce the risk of cardiovascular events, though a strategy to reduce blood pressure regardless of baseline blood pressure (ie, including people with diabetes who do not have raised blood pressure) has not been proven in randomised trials to date.” Lancet Press Release Sept 2007 What is recommended by guidelines?
7. ESH-ESC Guidelines 2007 2007 Guidelines for the Management of Arterial Hypertension. ESH/ESC. Journal of hypertension 2007,25:1105-1187 “ A combination of two drugs at low dose should be preferred as first step treatment when initial BP is in the grade 2 or 3 range or total cardiovascular risk is high or very high”
8.
9. From UKPDS to ADVANCE: 30 years of progress to improve cardiovascular-renal outcome in diabetics Glycemic control BP control Macro- and microvascular protection 1977 2007 RAAS Antiplatelet agents Statins ACE inhibitors ARBs Preterax ?
10. Myocardial Infarction Stroke Microvascular complications Non-intensive group (HbA1c = 7.9 %) UKPDS 33. Lancet 1998;352:837-853 P = 0.052 P = 0.0099 Intensive glycemic control reduces risk of CV events P = 0. 52 Intensive group (HbA1c = 7%) % Events
12. Cardiovascular mortality Stroke Myocardial infarction Ramipril (142/80 mm Hg) placebo (142/79 mm Hg) Micro-HOPE. Lancet 2000;355:253-259 P = 0.01 P = 0.0001 P = 0.07 Major benefits with ACE inhibitors regarding coronary and renal events Nephropathy P = 0.027 % Events
13. Antiplatelet agents reduce the risk of events In coronary diabetics: Cardiovascular mortality, MI, and stroke are reduced by 19% (p<0.01) JAMA. 2002;287:2570-2581 Statins reduce the risk of macrovascular events in diabetics Major cardiovascular events Stroke Coronary events placebo P = 0.001 atorvastatin P = 0.001 % Events CARDS. Lancet 2004;364:685-696
26. Preterax reduces CV mortality by 18% - 18% P = 0.027 ADVANCE Collaborative group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007. 2007;370:829-840
27. Preterax reduces total mortality by 14% - 14% P = 0.025 ADVANCE Collaborative group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007. 2007;370:829-840
28. Preterax reduces coronary and renal events ADVANCE Collaborative group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007. 2007;370:829-840
29. Major macro or microvascular event Preterax reduces combined primary outcomes by 9%- - 9 % P = 0.041 ADVANCE Collaborative group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007. 2007;370:829-840
30. Effects are consistent by age, sex, BP, and HbA1c Combined primary end point 2.0 Number of events Preterax Placebo (n=5569) (n=5571) Relative risk reduction (95% CI) Favors Preterax Favors Placebo Hazard ratio 0.5 1.0 Age (years) < 65 325 346 6% (-10 to 19) >= 65 536 592 11% (0 to 21) Sex Male 546 594 10% (-1 to 20) Female 315 344 8% (-7 to 21) SBP (mm Hg) < 140 309 341 10% (-5 to 23) ≥ 140 552 597 9% (-2 to 19) History of hypertension No 121 136 9% (-17 to 29) Yes 740 802 9% (0 to 18) HbA1c (%) ≤ 7.5 406 456 9% (-4 to 20) > 7.5 451 481 11% (-1 to 22) All participants 861 938 9% (0 to 17) ADVANCE Collaborative group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007. 2007;370:829-840
31. Effects are consistent whatever the ancillary treatment Combined primary end point 2.0 Number of events Preterax Placebo (n=5569) (n=5571) Relative risk reduction (95% CI) Favors Preterax Favors Placebo Hazard ratio 0.5 1.0 Treatment with any BP–lowering drug 177 183 6% (-15 to 24) 684 755 10% (0 to 19) Treatment with ACE inhibitor 417 455 10% (-3 to 21) 444 483 8% (-4 to 20) Treatment with statins 638 687 10% (0 to 19) 223 251 8% (-10 to 23) Treatment with antiplatelet drug 408 454 11% (-2 to 22) 453 484 7% (-5 to 18) All participants 861 938 9% (0 to 17) No Yes No Yes No Yes No Yes ADVANCE Collaborative group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007. 2007;370:829-840
32. Blood pressure reduction ADVANCE Collaborative group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007. 2007;370:829-840 140.3 mmHg 134.7 mmHg Average BP during follow-up 77.0 mmHg 74.8 mmHg
33.
34.
35.
36.
37. From UKPDS to ADVANCE: 30 years of progress in improving cardiovascular-renal outcome in diabetics Glycemic control BP control Macro- and microvascular protection 1977 2007 RAAS Antiplatelet agents Statins ACE inhibitors ARBs Preterax: YES 6
38.
39. If the benefits observed in ADVANCE were applied to just half the world’s diabetic population, approximately 1.5 million deaths would be avoided Potential global benefits of treatment in diabetic hypertensives. “ There is now a case for considering such treatment routinely for patients with type 2 diabetes” ADVANCE Collaborative group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007. 2007;370:829-840 EASD-ESC Guidelines 2007
40. ESH-ESC Guidelines 2007 2007 Guidelines for the Management of Arterial Hypertension. ESH/ESC. Journal of hypertension 2007,25:1105-1187 benefits of treatment in diabetic hypertensives.
41. Only ACE inhibitors have been proven to reduce mortality in diabetics Events ACE inhibitors vs placebo 36 trials n = 4008 ARBs vs placebo 4 trials n = 3331 Creatinemia - 40 % - 21 % Strippoli GF et al. BMJ. 2004;329:828-838 P = 0.04 Renal impairment - 36 % - 22 % Microalbuminuria - 51 % - 55 % Mortality - 1 % - 21 %
44. Risk factor levels at the end of follow-up * Measurements taken at month 48 ADVANCE Collaborative group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007. 2007;370:829-840 Randomized treatment Preterax (n=5569) Control (n=5571) Systolic BP (mm Hg) 135.6 139.9 Diastolic BP (mm Hg) 73.6 75.1 Haemoglobin A1c (%) 6.9 6.9 Total cholesterol (mmol/L) * 4.7 4.6 HDL cholesterol (mmol/L) * 1.3 1.3 LDL cholesterol (mmol/L) * 2.7 2.6 Triglycerides (mmol/L) * 1.8 1.7
45. Ancillary drug therapy At the end of follow-up ADVANCE Collaborative group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007. 2007;370:829-840 Randomized treatment Preterax (n=5569) Control (n=5571) Any BP–lowering drug 74% 83% ACE inhibitor 50% 60% Oral hypoglycemic drugs 90% 91% Insulin 33% 30% Statin 44% 45% Other lipid-modifying drug 8% 7% Aspirin 56% 55% Other antiplatelet drugs 6% 6%
46. ADVANCE started where UKPDS and Micro-HOPE left off Comparative patient profiles UKPDS Micro-HOPE ADVANCE BP (mm Hg) Active treatment at end follow-up 145/82 139/77 136/73 Use background ACE inhibitors No No Yes Use statins No + ++ HbA1c end follow-up 8. 3% 9.5% 6.9% Event rate, Total and CV mortality Stroke +++ ++ +++ +++ + +