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See detailÉtude climatologique des irrégularités ionosphériques détectées à l'aide des GNSS
Wautelet, Gilles ULg

Master of advanced studies dissertation (2007)

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See detailEtude clinique comparative de l'effet de la prostaglandine F2alpha sur la rétention placentaire chez la vache
Hanzen, Christian ULg; Baudoux, Ch

in Annales de Médecine Vétérinaire (1985), 129

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See detailEtude clinique d’une dyade, régressant en fonctionnement borderline au niveau contextuel, individuel et familial, caractérisée par un passage à l’acte abusif d’ordre sexuel
Aubinet, Suzanne ULg; D'Amore, Salvatore ULg; Cancrini, Luigi

in Thérapie Familiale (2013), 2

This research is based on Luigi Cancrini’s theory of regression in borderline functioning which provides a structured and nuanced reflection on sexual abuse. It offers the possibility of establishing a ... [more ▼]

This research is based on Luigi Cancrini’s theory of regression in borderline functioning which provides a structured and nuanced reflection on sexual abuse. It offers the possibility of establishing a framework for observation and analysis of both synchronic and diachronic blendings; the behavioral characteristics proposed by the victims, perpetrators and their families; and the historical sense that can give them. It leads to the identification of the central link connecting the actors and their life contexts. We analyze a clinical situation with sexual abuse. The chosen dyad, composed by a 7 year-old-girl and a 13 ½ year-old-boy, was observed in vivo during hospitalization. Relevant behavioral, relational and historical components were compiled in an analytic scale based on Cancrini (2009) and Barudy (1997) writings. Similar psychopathological functioning among perpetrators, victims and families could thus be seen within this framework. The comparison of the systems reported similar family dynamics within the different subsystems. For these children, this results in the emergence of a specific behavioral repertory, typical of a borderline functioning, characterizing both the perpetrator and the aggressed: both are embedded in rigid supporting dyadic relational patterns and intense cleaved positions, which are also found within the various systems and the individuals within them. [less ▲]

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See detailL'etude clinique du mois Quel antihypertenseur en premiere intention? Resultats de l'etude ALLHAT.
Scheen, André ULg; Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (2003), 58(1), 47-52

Antihypertensive therapy is well established to reduce hypertension-related morbidity and mortality, but the optimal first-step therapy is still controversial. The "Antihypertensive and Lipid-Lowering ... [more ▼]

Antihypertensive therapy is well established to reduce hypertension-related morbidity and mortality, but the optimal first-step therapy is still controversial. The "Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial" (ALLHAT) should give such an answer. It is a randomised, double-blind, trial designed to determine whether treatment with either a calcium channel blocker or an angiotensin-converting enzyme inhibitor lowers the incidence of coronary heart disease (CHD) or other cardiovascular disease (CVD) events vs treatment with a diuretic. A total of 33,357 participants aged 55 years or older with mild to moderate hypertension and at least 1 other CHD risk factor were randomly assigned to receive chlorthalidone (12.5 to 25 mg/day; n = 15,255), amlodipine (2.5 to 10 mg/day; n = 9,048) or lisinopril (10 to 40 mg; n = 9,054). The primary outcome combined both fatal CHD and non-fatal myocardial infarction, analyzed by intent-to-treat. Secondary outcomes were all-causes mortality, stroke, combined CHD (primary outcome, coronary revascularization, or angina with hospitalization), and combined CVD (combined CHD, stroke, treated angina without hospitalization, heart failure and peripheral arterial disease). Chlorthalidone was slightly more effective in reducing systolic pressure while amlodipine reduced slightly more effectively diastolic blood pressure. After a mean follow up of 4.9 years, no differences were observed between the three treatments regarding both the primary outcome and the total mortality. Secondary outcomes were similar when comparing amlodipine vs chlorthalidone. A moderately higher 6-year incidence rate of clinically detected heart failure was observed with amlodipine, but without significant influence on mortality. For lisinopril vs chlorthalidone, lisinopril had slightly higher 6-year rates of combined CVD, stroke and heart failure. In conclusion, thiazide-type diuretics are superior in preventing one or more major forms of CVD and offer the advantage to be cheaper. They should be preferred for first-step antihypertensive therapy. However, to reach the recommended blood pressure target, most patients should receive a combination of antihypertensive compounds. Such a combination should always comprise a diuretic agent, in absence of contra-indications. [less ▲]

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See detailL'etude clinique du mois. ACCORD-LIPID et ACCORD-EYE: vers un nouveau positionnement du fenofibrate chez le patient diabetique de type 2.
Scheen, André ULg; Van Gaal, L. F.

in Revue Médicale de Liège (2010), 65(9), 533-9

Fenofibrate has been evaluated in the ACCORD trial, in combination with a statin, to prevent vascular complications in patients with type 2 diabetes. In ACCORD-Lipid, the addition of fenofibrate was not ... [more ▼]

Fenofibrate has been evaluated in the ACCORD trial, in combination with a statin, to prevent vascular complications in patients with type 2 diabetes. In ACCORD-Lipid, the addition of fenofibrate was not able to significantly reduce the incidence of a composite cardiovascular endpoint (no positive effect was also observed with the intensification of blood glucose or blood pressure control in this population). However, an interaction effect was observed according to basal lipid profile, suggesting a better protection by fenofibrate in patients with hypertriglyceridaemia and low HDL cholesterol (so-called atherogenic dyslipidaemia). In ACCORD-Eye, the addition of fenofibrate to a basal statin therapy resulted in a significant reduction of the progression of diabetic retinopathy, in a similar manner as that observed with intensifying blood glucose control (but with a good safety profile and without increasing the risk of hypoglycaemia). These observations, confirming earlier results from FIELD also with this fibrate, open new perspectives for a useful prescription of fenofibrate in patients with type 2 diabetes. [less ▲]

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See detailL'etude clinique du mois. ADVANCE: amelioration de la survie et reduction des complications vasculaires et renales avec la combinaison fixe perindopril-indapamide chez le patient diabetique de type 2.
Scheen, André ULg; Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (2007), 62(10), 639-43

The controlled ADVANCE trial compared the incidence of major macrovascular and microvascular complications in 5,569 type 2 diabetic patients randomised to a fixed combination of perindopril and indapamide ... [more ▼]

The controlled ADVANCE trial compared the incidence of major macrovascular and microvascular complications in 5,569 type 2 diabetic patients randomised to a fixed combination of perindopril and indapamide and in 5,571 patients randomised to placebo, followed for a mean duration of 4.3 years. Compared with patients assigned placebo, those assigned active therapy had a mean reduction in systolic blood pressure of 5.6 mm Hg and diastolic blood pressure of 2.2 mm Hg, despite the fact physicians were allowed to adjust antihypertensive therapy ad libitum. The relative risk of a major macrovascular and microvascular event (primary endpoint) was reduced by 9% (p = 0.041) in the active group. The separate reductions in macrovascular and microvascular events were similar but were not independently statistically significant. The relative risk of death was significantly reduced by 14% (p = 0.025), essentially due to a lower death rate from cardiovascular diseases (-18%; p = 0.027). The incidence of any coronary event was also significantly reduced (-14 %; p = 0.020), while only a trend was observed for all cerebrovascular events. Finally, renal events were significantly less frequent (-21%; p < 0.0001) whereas all ocular events were only slightly reduced (-5%; NS) in the active group as compared to the placebo group. The fixed combination of perindopril and indapamide was well tolerated and easy to administer. Overall one death due to any cause would be averted among every 79 diabetic patients assigned active therapy for 5 years. There was no evidence that the effects of the study treatment differed by initial blood pressure level or concomitant use of other treatments at baseline. [less ▲]

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See detailL'etude clinique du mois. Apres la tempete sur les anorexigenes centraux, l'etude "STORM" avec la sibutramine.
Scheen, André ULg

in Revue Médicale de Liège (2001), 56(1), 56-8

The results of the "Sibutramine Trial of Obesity Reduction and Maintenance" (STORM) published in the last issue of December 2000 of the Lancet are summarized. This clinical trial (open label for the first ... [more ▼]

The results of the "Sibutramine Trial of Obesity Reduction and Maintenance" (STORM) published in the last issue of December 2000 of the Lancet are summarized. This clinical trial (open label for the first 6 months and double blind versus placebo for a further 18 months) demonstrates the positive effect of sibutramine, a new anorectic drug, on long-term weight maintenance after weight loss in obese subjects. The benefit of sibutramine on the cardiovascular risk profile of the obese patient is more particularly discussed. [less ▲]

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See detailL'etude clinique du mois. Balance benefice/risque du traitement oestroprogestatif postmenopausique en peril dans l'etude Women's Health Initiative: attitude pratique du clinicien
Gaspard, Ulysse ULg; van den Brule, F.; PINTIAUX, Axelle ULg et al

in Revue Médicale de Liège (2002), 57(8), 556-62

The Women's Health Initiative (WHI) is sponsored by the NIH. The study focuses on risk and benefits of strategies that could potentially reduce the incidence of heart disease, breast and colon cancer, and ... [more ▼]

The Women's Health Initiative (WHI) is sponsored by the NIH. The study focuses on risk and benefits of strategies that could potentially reduce the incidence of heart disease, breast and colon cancer, and fractures in postmenopausal women. One arm of the study, a double-blind, placebo-controlled trial, looking at the effects of continuous combined estrogen-progestin regimen was stopped prematurely based on health risks which exceeded health benefits. The main reason for this decision was the increase in risk of invasive breast cancer, as well as a slight increase in the rate of myocardial infarction and stroke. In this paper, we inform our colleagues of the detailed results of the study. We comment on its limitation and discuss the new original observations. Finally, we integrate the others to previous world literature data that are confirmed by the WHI study. It is important for the individual prescribing practitioner to issue practical conclusions and therapeutic recommendations. The department of Obstetrics and Gynaecologic of the University of Liege, in agreement with the European Menopause Society and the International Menopause Society, is convinced that there is no alternative to the hormone replacement therapy for menopausal symptoms. We should stick to the traditional indications for hormones, namely vasomotor symptoms and osteoporosis. We should continue to recommend hormones for symptomatic women. One should realize that the risk for breast cancer appears only after several years of use, and the risk for cardiovascular events below age 60 is very small (the age of the patients was 63 at inclusion in the WHI study). We should encourage women to take the necessary measures for routine, periodic breast examinations (both manual, echographic and radiographic). Women who use HRT for more than 5 years should discuss the latest data of the WHI study with their physician, in order to consider their individual benefit-risk equation. Those who feel good on hormones and are fully satisfied with this treatment should learn of possible harm after long-term use. It is important to take into account the importance of quality of life. We should leave to the patient the final decision whether or not to continue the treatment. It is presently impossible to decide whether other estroprogestin associations, other administration routes and other molecules such as estradiol, natural progesterone or other progestins, SERMS and Tibolone could have an impact very different from that of the estroprogestin combination used in the WHI study. It is the duty of every physician to decide, from the complex epidemiological data obtained in the aged women (63-68 years) with a high cardiovascular risk in the WHI study, if it is possible or not in each individual case to recommend the initiation or pursue of an hormone replacement therapy. [less ▲]

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See detailL'etude clinique du mois. Chirurgie bariatrique: les resultats a 10 ans de la Swedish Obese Subjects Study"."
Scheen, André ULg; Letiexhe, Michel ULg; Rorive, Marcelle ULg et al

in Revue Médicale de Liège (2005), 60(2), 121-5

The 10-year results of the prospective, controlled Swedish Obese Subjects Study were recently reported in the New England Journal of Medicine by L. Sjostrom and colleagues. This trial compared obese ... [more ▼]

The 10-year results of the prospective, controlled Swedish Obese Subjects Study were recently reported in the New England Journal of Medicine by L. Sjostrom and colleagues. This trial compared obese subjects who underwent gastric surgery and contemporaneously matched, conventionally treated obese control subjects. The follow-up rate for laboratory examinations was 74.5 percent at 10 years. At that time, data of 627 patients of the control group (mean age of 48 years, body mass index of 41 kg/m2) were compared to those of 641 patients who were submitted to surgery (banding n = 156, vertical banded gastroplasty n = 451 and gastric bypass n =34). At 10 years, the body weight had increased by 1.6 percent in the control group and decreased by 16.1 percent in the surgery group (p < 0.001), and similar changes were observed for waist circumference (+2.8 percent versus -10.1 percent, respectively, p < 0.001). Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period. Ten-year rates of recovery from diabetes, hypertriglyceridaemia, low levels of high-density lipoprotein cholesterol, hypertension, and hyperuricaemia were more favourable in the surgery than in the control group. The surgery group had lower 10-year incidence rates of diabetes, hypertriglyceridaemia, and hyperuricaemia (but not of hypertension) than the control group. In conclusion, as compared with conventional therapy, bariatric surgery appears to be a valuable option for the treatment of severe obesity, resulting in long-term weight loss, improved lifestyle, and, except for hypercholesterolaemia that was not significantly affected, amelioration in cardiovascular risk factors that were elevated at baseline. Obtaining long-term data concerning the effect of weight loss on overall mortality and on the incidence rates of myocardial infarction, stroke, and cancer remains a key-objective of this landmark study. [less ▲]

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See detailL'etude clinique du mois. Controle glycemique et morbimortalite cardio-vasculaire chez le patient diabetique de type 2. Resultats des etudes ACCORD, ADVANCE et VA-Diabetes.
Radermecker, Régis ULg; Philips, Jean-Christophe ULg; Jandrain, Bernard ULg et al

in Revue Médicale de Liège (2008), 63(7-8), 511-8

Type 2 diabetes is associated with a high risk of complications, essentially macrovascular events. Surprisingly, the effect of improved glucose control on coronary and cerebrovascular complications in ... [more ▼]

Type 2 diabetes is associated with a high risk of complications, essentially macrovascular events. Surprisingly, the effect of improved glucose control on coronary and cerebrovascular complications in this population remains questionable. Furthermore, the target level of glycated haemoglobin (HbA1c) to minimise the risk of diabetic complications is controversial. We report the results of three recent randomised control trials (ACCORD, ADVANCE, Veterans Affairs Diabetes), which assessed the impact on cardiovascular events of intensive glucose-lowering therapy. None of these studies was able to demonstrate a significant reduction of cardiovascular events in the intensive group as compared to the standard group. On the contrary, in ACCORD, the study with the most ambitious goal (HbA1c < 6%), the overall and cardiovascular mortality was greater in the intensive group. In contrast, in the ADVANCE trial, the mortality and the incidence of cardiovascular events were not statistically different between the two treatment groups, whereas the risk of microangiopathic complications, especially nephropathy, was significantly decreased in the intensive group (HbA1c < or = 6.5%, with modified release gliclazide as main treatment). Finally, VA-Diabetes showed that the effect of better glucose control on cardiovascular complications disappeared with duration of the disease and that the risk of cardiovascular events increased in patients with severe hypoglycaemic episodes. In the three studies, the hypoglycaemic risk was indeed increased in the intensive group, which may contribute to reduce the positive impact of better glucose control on cardiovascular complications. The best way to protect type 2 diabetic patients against coronary and cerebrovascular disease is to target all cardiovascular risk factors. [less ▲]

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See detailEtude clinique du mois. Effets du valsartan dans l'insuffisance cardiaque chronique: l'etude Val-HeFT
Pierard, Luc ULg

in Revue Médicale de Liège (2002), 57(1), 57-9

Current guidelines recommend drugs which reduce neurohormonal activation as standard therapy for heart failure: angiotensin converting-enzyme (ACE) inhibitors, beta-blockers and spironolactone. The ... [more ▼]

Current guidelines recommend drugs which reduce neurohormonal activation as standard therapy for heart failure: angiotensin converting-enzyme (ACE) inhibitors, beta-blockers and spironolactone. The Valsartan Heart Failure Trial (Val-HeFT) tested the efficacy of the angiotensin-receptor blocker valsartan in addition to prescribed therapy. A total of 5010 patients with heart failure of NYHA class II, III or IV were randomly assigned to receive 160 mg of valsartan or placebo twice daily. Further angiotensin antagonism by valsartan did not improve survival but was beneficial in terms of morbidity and mortality, because of reduced rate of hospitalization, significant improvements in NYHA class, ejection fraction, signs and symptoms of heart failure, and quality of life. Valsartan had highly favourable effects in patients not receiving ACE inhibitors but an adverse effect in patients receiving both ACE inhibitors and beta-blockers. The effects of adding valsartan are depending on the importance of previous neurohormonal inhibition. [less ▲]

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See detailL'etude clinique du mois. Essais de preservation des cellules B a la phase initiale du diabete de type 1: resultats negatifs avec l'insuline retard, mais prometteurs avec un anticorps monoclonal anti-CD3.
Philips, Jean-Christophe ULg; Scheen, André ULg

in Revue Médicale de Liège (2002), 57(6), 413-7

Type 1 diabetes is an autoimmune disease leading to a progressive exhaustion of the insulin secretion and a destruction of the B-cells. Attempts of preservation of insulin-producing B-cells can be ... [more ▼]

Type 1 diabetes is an autoimmune disease leading to a progressive exhaustion of the insulin secretion and a destruction of the B-cells. Attempts of preservation of insulin-producing B-cells can be performed at an early, most often silent, stage of the disease in well-selected at high risk subjects or during the period immediately following the clinical diagnosis based upon classical signs of hyperglycaemia. In the "Diabetes Prevention Trial-Type 1", the prophylactic subcutaneous administration of low-dose ultralente insulin was not able to prevent the development of type 1 diabetes nor to preserve residual insulin secretion in young relatives at very high-risk of diabetes, selected upon genetic, immunological and metabolic criteria. In contrast, a pilot randomized trial shows that a treatment with a nonactivating humanized monoclonal antibody against CD3 mitigates the deterioration in insulin production and improves metabolic control, with lower dose of exogenous insulin, during the first year of type 1 diabetes mellitus in 9 out of 12 treated patients. Besides a better understanding of the natural history of the disease, these clinical trials open new perspectives for prevention of type 1 diabetes mellitus, currently assessed by the Belgian Diabetes Registry. [less ▲]

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See detailL'etude clinique du mois. Etudes cliniques a long terme (1-2 ans) avec l'orlistat, nouveau medicament pour le traitement de l'obesite.
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(8), 707-9

Orlistat (Xenical), whose original mechanism of action consists of the selective inhibition of gastrointestinal lipases, has been recently commercialized for the treatment of obesity. Despite its recent ... [more ▼]

Orlistat (Xenical), whose original mechanism of action consists of the selective inhibition of gastrointestinal lipases, has been recently commercialized for the treatment of obesity. Despite its recent launch and when compared to common anorectic agents, it has been much better evaluated in long-term trials carried out according to the rules of Good Clinical Practice. We will summarize the four recently published randomized, placebo-controlled, double-blind clinical trials lasting up to 1 to 2 years and evaluating the effects of orlistat 3 x 120 mg/day in obese patients (BMI > or = 28 kg/m2). [less ▲]

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See detailL'etude clinique du mois. Insulino-independance prolongee apres transplantation d'ilots de langerhans chez le patient diabetique de type 1: l'aboutissement d'un reve?
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(8), 803-5

A Canadian research team recently reported a series of 7 consecutive patients with type 1 brittle diabetes who could achieve sustained excellent metabolic control in the absence of insulin therapy after ... [more ▼]

A Canadian research team recently reported a series of 7 consecutive patients with type 1 brittle diabetes who could achieve sustained excellent metabolic control in the absence of insulin therapy after successful islet transplantation. This exceptional success, which contrasts with previous less favourable results, is probably due to the transplantation of a higher number of islets of good quality and to the use of a new glucocorticoid-free immunosuppressive regimen. These remarkable results which provide proof of the principle that islet transplantation can be reproducibly successful, at least for one year, may raise new hope in patients with type 1 diabetes. However, the problem of supply and demand of islets is huge and will require a careful, and probably difficult, selection of the best candidates to benefit from this new therapeutic approach. [less ▲]

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See detailL'etude clinique du mois. Interet d'augmenter un taux de cholesterol HDL bas en prevention secondaire de la coronaropathie: resultats de l'etude VA-HIT.
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(9), 773-5

The "Veterans Affairs Cooperative Studies Program High-Density Lipoprotein Cholesterol Intervention Trial" (VA-HIT) is a large randomised, double-blind, placebo-controlled clinical trial for the secondary ... [more ▼]

The "Veterans Affairs Cooperative Studies Program High-Density Lipoprotein Cholesterol Intervention Trial" (VA-HIT) is a large randomised, double-blind, placebo-controlled clinical trial for the secondary prevention of coronary heart disease. It demonstrates that a fibrate treatment (gemfibrozil) significantly reduces the relative risk of major coronary (-22%, p = 0.006) and cardiovascular (-24%, p < 0.001) events in men with coronary heart disease whose primary lipid abnormality is a low HDL cholesterol level. These findings suggest that, in such a population, the rate of coronary events is reduced under gemfibrozil therapy by raising HDL cholesterol levels (+6%) and lowering levels of triglycerides (-31%) without lowering LDL cholesterol concentrations. [less ▲]

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See detailL'etude clinique du mois. INTERHEART": la preuve par 9. Neuf facteurs de risque predisent neuf infarctus du myocarde sur dix."
Scheen, André ULg; Kulbertus, Henri ULg

in Revue Médicale de Liège (2004), 59(11), 676-9

INTERHEART is a standardised case-control study of acute myocardial infarction in 52 countries representing every inhabited continent. 15152 cases and 14820 controls were enrolled. Collectively, 9 factors ... [more ▼]

INTERHEART is a standardised case-control study of acute myocardial infarction in 52 countries representing every inhabited continent. 15152 cases and 14820 controls were enrolled. Collectively, 9 factors accounted for 90% of myocardial infarctions in men and 94% in women. These factors were 6 risk factors (dyslipidaemia characterized by high apoB/apoA1 ratio, smoking, hypertension, diabetes mellitus, abdominal obesity and stressful psychosocial factors) and 3 protective factors (daily consumption of fruits and vegetables, regular alcohol consumption, and regular physical activity). These findings suggest that interventions targeting these 9 factors have the potential to prevent most premature cases of myocardial infarction and that these strategies should be implemented worldwide. [less ▲]

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See detailL'étude clinique du mois. JUPITER : diminution par la rosuvastatine des accidents cardio-vasculaires et de la mortalité chez des sujets sains normolipémiques avec C-réactive protéine accrue
Scheen, André ULg

in Revue Médicale de Liège (2008), 63(12), 749-753

SUMMARY : High levels of high-sensitivity C-reactive protein (hs-CRP) are an independent cardiovascular marker, which may be reduced by statin therapy. JUPITER is a randomised clinical trial that compares ... [more ▼]

SUMMARY : High levels of high-sensitivity C-reactive protein (hs-CRP) are an independent cardiovascular marker, which may be reduced by statin therapy. JUPITER is a randomised clinical trial that compares the effects of rosuvastatin 20 mg (n = 8901) and placebo (n = 8901) in apparently healthy individuals, <br />without hyperlipidaemia (LDL < 130 mg/dl ; median 108 mg/dl), but with moderately elevated hs-CRP levels (> 2 mg/l ; median 4.25 mg/l). Rosuvastatin reduced LDL cholesterol by 50 % (to a median of 55 mg/dl) and hs-CRP by 37 %. The trial, which should last 5 years, was stopped after a median follow-up of 1.9 years because of an imbalance in favour of the rosuvastatin group. Indeed, when compared to placebo, rosuvastatin <br />was associated with a relative risk reduction in the composite primary end point of 44 %, in myocardial infarction of 54 %, in stroke of 48 %, in revascularization procedures or hospitalisations for unstable angina of 47 %, in major cardiovascular <br />events (myocardial infarction, stroke and death) of 47 % and in deaths from any cause of 20 %. Consistent effects were observed in all subgroups evaluated. The only adverse event was a higher incidence of physician-reported diabetes in the rosuvastatin group compared to the placebo group. This study demonstrates that rosuvastatin 20 mg reduces the incidence <br />of cardiovascular events, including total mortality, in apparently healthy persons without hyperlipidaemia, but with elevated hs-CRP. However, the design of the trial does not allow discriminating which part of the favourable effect results from the drastic reduction in LDL cholesterol and which part results from the reduction in hs-CRP stricto sensu. [less ▲]

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See detailL'etude clinique du mois. L'apres DCCT, l'etude EDIC.
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(3), 187-9

The "Diabetes Control and Complications Trial" (DCCT) demonstrated that intensive insulin therapy, by reducing HbA1c levels by about 2%, delays the onset and slows the progression of microangiopathic ... [more ▼]

The "Diabetes Control and Complications Trial" (DCCT) demonstrated that intensive insulin therapy, by reducing HbA1c levels by about 2%, delays the onset and slows the progression of microangiopathic complications (by at least 50%) in patients with type 1 diabetes. The "Epidemiology of Diabetes Interventions and Complications" (EDIC) study recently showed that the reduction in the risk of progressive retinopathy and nephropathy resulting from intensive therapy during the DCCT not only persists, but is amplified for at least 4 years (reduction by about 80% when compared to diabetic patients previously treated with conventional therapy during the DCCT). [less ▲]

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See detailL'etude clinique du mois. L'etude ADOPT: quel antidiabetique oral initier chez le patient diabetique de type 2?
Scheen, André ULg

in Revue Médicale de Liège (2007), 62(1), 48-52

ADOPT ("A Diabetes Outcome Progression Trial") is a double-blind, controlled clinical trial that aims at assessing the efficacy of rosiglitazone, as compared to metformin or glibenclamide, in maintaining ... [more ▼]

ADOPT ("A Diabetes Outcome Progression Trial") is a double-blind, controlled clinical trial that aims at assessing the efficacy of rosiglitazone, as compared to metformin or glibenclamide, in maintaining long-term glycaemic control in patients with recently diagnosed type 2 diabetes. It randomized 4,360 patients who were followed for a median of 4.0 years. The cumulative incidence of monotherapy failure (defined as a confirmed level of fasting plasma glucose level of more than 180 mg/dl) averaged at 5 years 15% with rosiglitazone, 21% with metformin, and 34% with glibenclamide. This represents a risk reduction for rosiglitazone of 32% as compared to metformin and 63% as compared to glibenclamide (P < 0.001 for both comparisons). Rosiglitazone was associated with more weight gain and edema, metformin with a higher incidence of gastrointestinal events and glibenclamide with a higher risk of hypoglycaemia (P < 0.001). In conclusion, ADOPT showed better glycaemic durability with rosiglitazone monotherapy, compared to metformin or glibenclamide. The potential risks and benefits, the profile of adverse events, and the costs of the three drugs should all be considered to help inform the choice of pharmacotherapy for patients with type 2 diabetes. [less ▲]

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