Article (Scientific journals)
Effect of valsartan on the incidence of diabetes and cardiovascular events.
McMurray, John J; Holman, Rury R; Haffner, Steven M et al.
2010In New England Journal of Medicine, 362 (16), p. 1477-90
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Keywords :
Angiotensin II Type 1 Receptor Blockers/adverse effects/therapeutic use; Blood Glucose/analysis/drug effects; Blood Pressure/drug effects; Body Weight/drug effects; Cardiovascular Diseases/epidemiology/mortality/prevention & control; Cyclohexanes/therapeutic use; Diabetes Mellitus, Type 2/epidemiology/prevention & control; Double-Blind Method; Drug Therapy, Combination; Exercise; Female; Follow-Up Studies; Glucose Intolerance/diet therapy/drug therapy/therapy; Humans; Hypoglycemic Agents/therapeutic use; Incidence; Male; Middle Aged; Phenylalanine/analogs & derivatives/therapeutic use; Proportional Hazards Models; Risk Factors; Tetrazoles/adverse effects/therapeutic use; Valine/adverse effects/analogs & derivatives/therapeutic use
Abstract :
[en] BACKGROUND: It is not known whether drugs that block the renin-angiotensin system reduce the risk of diabetes and cardiovascular events in patients with impaired glucose tolerance. METHODS: In this double-blind, randomized clinical trial with a 2-by-2 factorial design, we assigned 9306 patients with impaired glucose tolerance and established cardiovascular disease or cardiovascular risk factors to receive valsartan (up to 160 mg daily) or placebo (and nateglinide or placebo) in addition to lifestyle modification. We then followed the patients for a median of 5.0 years for the development of diabetes (6.5 years for vital status). We studied the effects of valsartan on the occurrence of three coprimary outcomes: the development of diabetes; an extended composite outcome of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, arterial revascularization, or hospitalization for unstable angina; and a core composite outcome that excluded unstable angina and revascularization. RESULTS: The cumulative incidence of diabetes was 33.1% in the valsartan group, as compared with 36.8% in the placebo group (hazard ratio in the valsartan group, 0.86; 95% confidence interval [CI], 0.80 to 0.92; P<0.001). Valsartan, as compared with placebo, did not significantly reduce the incidence of either the extended cardiovascular outcome (14.5% vs. 14.8%; hazard ratio, 0.96; 95% CI, 0.86 to 1.07; P=0.43) or the core cardiovascular outcome (8.1% vs. 8.1%; hazard ratio, 0.99; 95% CI, 0.86 to 1.14; P=0.85). CONCLUSIONS: Among patients with impaired glucose tolerance and cardiovascular disease or risk factors, the use of valsartan for 5 years, along with lifestyle modification, led to a relative reduction of 14% in the incidence of diabetes but did not reduce the rate of cardiovascular events. (ClinicalTrials.gov number, NCT00097786.)
Disciplines :
Endocrinology, metabolism & nutrition
Cardiovascular & respiratory systems
Pharmacy, pharmacology & toxicology
Author, co-author :
McMurray, John J
Holman, Rury R
Haffner, Steven M
Bethel, M Angelyn
Holzhauer, Bjorn
Hua, Tsushung A
Belenkov, Yuri
Boolell, Mitradev
Buse, John B
Buckley, Brendan M
Chacra, Antonio R
Chiang, Fu*-Tien
Charbonnel, Bernard
Chow, Chun*-Chung
Davies, Melanie J
Deedwania, Prakash
Diem, Peter
Einhorn, Daniel
Fonseca, Vivian
Fulcher, Gregory R
Gaciong, Zbigniew
Gaztambide, Sonia
Giles, Thomas
Horton, Edward
Ilkova, Hasan
Jenssen, Trond
Kahn, Steven E
Krum, Henry
Laakso, Markku
Leiter, Lawrence A
Levitt, Naomi S
Mareev, Viacheslav
Martinez, Felipe
Masson, Chantal
Mazzone, Theodore
Meaney, Eduardo
Nesto, Richard
Pan, Changyu
Prager, Rudolf
Raptis, Sotirios A
Rutten, Guy E H M
Sandstroem, Herbert
Schaper, Frank
Scheen, André  ;  Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Schmitz, Ole
Sinay, Isaac
Soska, Vladimir
Stender, Steen
Tamas, Gyula
Tognoni, Gianni
Tuomilehto, Jaako
Villamil, Alberto S
Vozar, Juraj
Califf, Robert M
More authors (44 more) Less
Language :
English
Title :
Effect of valsartan on the incidence of diabetes and cardiovascular events.
Publication date :
2010
Journal title :
New England Journal of Medicine
ISSN :
0028-4793
eISSN :
1533-4406
Publisher :
Massachusetts Medical Society, Waltham, United States - Massachusetts
Volume :
362
Issue :
16
Pages :
1477-90
Peer reviewed :
Peer Reviewed verified by ORBi
Additional URL :
Commentary :
2010 Massachusetts Medical Society
Available on ORBi :
since 03 May 2010

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