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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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See detailL'etude clinique du mois. L'etude ALLHAT-LLT.
Kulbertus, Henri ULg; Scheen, André ULg

in Revue Médicale de Liège (2003), 58(1), 53-8

ALLHAT-LLT was part of the ALLHAT study. The purpose was to determine whether pravastatin compared with usual care reduces all-cause mortality in older, moderately hypercholesterolaemic, hypertensive ... [more ▼]

ALLHAT-LLT was part of the ALLHAT study. The purpose was to determine whether pravastatin compared with usual care reduces all-cause mortality in older, moderately hypercholesterolaemic, hypertensive patients with at least one additional coronary heart disease (CHD) risk factor. 10,355 ambulatory patients, aged 55 years or more, with LDL cholesterol of 120-189 mg/dl (or, 100-129 mg/dl if known CHD) and triglycerides < 350 mg/dl, were randomised to pravastatin (40 mg/d; n = 5,170), or usual care (n = 5,185). Mean age was 66 years; 49% were women; 38% were black and 23% hispanic; 14% had a history of CHD and 35%, type 2 diabetes. Baseline mean total cholesterol was 224 mg/dl; LDL-C, 146 mg/dl; HDL-C, 48 mg/dl, and triglycerides, 152 mg/dl. Mean follow-up was 4.8 years. Among usual care patients, 32% of those with known CHD and 29% of those without CHD started taking lipid-lowering drugs. At year 4, total cholesterol was reduced by 17.2% with pravastatin and by 7.6% with usual care. A random sample had their LDL-C levels assessed: there was a reduction of 28% with pravastatin and of 11% with usual care. All-cause mortality was similar in the two groups (RR, 0.99; 95% CI, 0.89-1.11; p = 0.88), with 6-year mortality rates of 14.9% (pravastatin) and 15.3% (usual care). CHD event-rates were not different between the two groups (RR, 0.91; 95% CI, 0.79-1.04; p = 0.16); 6-year CHD event rates were 9.3% (pravastatin) and 10.4% (usual care), respectively. These results are likely due to the small differential in total cholesterol (9.6%) and LDL-C (16.7%) between pravastatin and usual care, compared with prior statin trials. Such an unusual differential essentially results from the open table of the study and from the possibility of prescribing a statin in the usual care group. [less ▲]

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See detailL'etude clinique du mois. L'etude CALM ou interet de combiner un inhibiteur de l'enzyme de conversion et un antagoniste du recepteur de type 1 de l'angiotensine II dans le traitement de la nephropathie diabetique.
Philips, Jean-Christophe ULg; Weekers, Laurent ULg; Scheen, André ULg

in Revue Médicale de Liège (2001), 56(2), 126-8

The main objective of the CALM (Candesartan And Lisinopril Microalbuminuria) study is to assess the effect of a dual blockade of the renin-angiotensin system--using both an angiotensin converting enzyme ... [more ▼]

The main objective of the CALM (Candesartan And Lisinopril Microalbuminuria) study is to assess the effect of a dual blockade of the renin-angiotensin system--using both an angiotensin converting enzyme inhibitor (ACE-I) and an angiotensin II type 1 receptor blocker--in patients with type 2 diabetes, high blood pressure and microalbuminuria. The study included 200 patients randomized to receive candesartan 16 mg or lisinopril 20 mg for 12 weeks, followed by 12 weeks of the same monotherapy or a combination treatment. Main outcomes are the reduction of microalbuminuria and blood pressure. All three of the treatments are effective, but the dual blockade is respectively 18%, 8 mmHg and 5 mmHg more effective in reducing microalbuminuria, systolic and diastolic blood pressure. No comparison is made between this "new" association and the more frequently used biotherapy (i.e. ACE-I plus thiazidic diuretic) and therefore its usefulness in regular practice is still to be determined. [less ▲]

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See detailL'etude clinique du mois. L'etude CAPPP: "The Captopril Prevention Project".
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(3), 197-9

The Captopril Prevention Project (CAPPP) was a prospective, randomized, open trial which aimed at comparing the prevention by captopril (n = 5492) or by a conventional treatment (n = 5493; diuretics or ... [more ▼]

The Captopril Prevention Project (CAPPP) was a prospective, randomized, open trial which aimed at comparing the prevention by captopril (n = 5492) or by a conventional treatment (n = 5493; diuretics or beta-blockers) of cardiovascular morbidity and mortality in patients with hypertension (diastolic blood pressure > 100 mmHg). After a mean follow-up of 6.1 years, the results regarding the primary endpoint and most secondary endpoints were not significantly different between the two therapeutic modalities. The only differences (perhaps due to a randomisation bias) were a slightly higher incidence of stroke, but a lower risk of diabetes mellitus, in the captopril group than in the group receiving conventional treatment. In conclusion, the CAPPP study demonstrates, for the first time, that captopril, an angiotensin-converting-enzyme inhibitor, is as effective as conventional treatment with diuretics or beta-blockers, two drugs whose efficacy has already been demonstrated when compared to placebo, in the prevention of cardiovascular morbidity and mortality in hypertensive patients. [less ▲]

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See detailL'étude clinique du mois. L'étude CHARISMA: à la recherche de la meilleure stratégie antiagrégante plaquettaire en prévention cardio-vasculaire.
Scheen, André ULg

in Revue Médicale de Liège (2006), 61(9), 656-61

The CHARISMA ("Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance") trial compared the effects of a dual antiplatelet therapy with clopidogrel plus low dose ... [more ▼]

The CHARISMA ("Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance") trial compared the effects of a dual antiplatelet therapy with clopidogrel plus low dose aspirin with those of a monotherapy with aspirin (75-162 mg/day) on the incidence of cardiovascular events in 15,603 patients at high risk for atherothrombotic events followed for a median of 28 months. The primary efficacy endpoint, a composite of myocardial infarction, stroke, or death from cardiovascular causes, was not significantly different between the two treatment arms. The secondary principal efficacy endpoint, which included all hospitalizations for ischaemic events, was slightly reduced in the group with clopidogrel-aspirin as compared to the group with placebo-aspirin. In a subgroup analysis, among so-called "symptomatico" patients (79 % of the studied population), the dual antiplatelet therapy was associated with a significantly lower incidence of events than aspirin alone, including the primary efficacy end point. On the contrary, in "asymptomatic" patients, such a favourable effect was not observed. Unexpectedly, in this subgroup, a paradoxical increase in the mortality rate was observed with the clopidogrel-aspirin combination. As far as safety was concerned, the risk of severe (difference not significant) and moderate (difference significant) bleeding was higher in patients with the clopidogrel-aspirin combination. In conclusion, acetylsalicylic acid (aspirin) is the first choice drug and the only antiplatelet agent to be used in prvention of cardiovascular disease. In secondary prevention, the addition of clopidogrel may reinforce the cardiovascular protection given by aspirin in "symptomatic" patients, but at the expense of a slightly higher bleeding rate. [less ▲]

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See detailEtude clinique du mois. L'etude DREAM: prevention du diabete de type 2 par le ramipiril et/ou la rosiglitazone chez les personnes dysglycemiques sans maladie cardio-vasculaire.
Scheen, André ULg

in Revue Médicale de Liège (2006), 61(10), 728-32

DREAM ("Diabetes Reduction Assessment with ramipril and rosiglitazone Medication") is a double-blind randomised placebo-controlled clinical trial with a 2-by-2 factorial design aiming to study the effects ... [more ▼]

DREAM ("Diabetes Reduction Assessment with ramipril and rosiglitazone Medication") is a double-blind randomised placebo-controlled clinical trial with a 2-by-2 factorial design aiming to study the effects of an ACE inhibitor (ramipril 15 mg/day) and/or a thiazolidinedione (rosiglitazone 8 mg/day) on the development of diabetes or death (primary outcome) and on the regression to normoglycaemia (secondary outcome) in 5269 adults aged 30 years or more with impaired fasting glucose and/or impaired glucose tolerance, and no previous cardiovascular disease. There was no statistical evidence of an interaction between the ramipril and the rosiglitazone arms. After a mean follow up of 3 years, the use of ramipril does not significantly reduce the incidence of diabetes or death but does significantly increase regression to normoglycaemia. In contrast, the treatment with rosiglitazone reduces by almost 60% the incidence of type 2 diabetes and increases the likelihood (+70%) of regression to normoglycaemia. Whether it is a true prevention effect or simply a treatment effect remains to be determined when participants will be retested after a washout period. Cardiovascular event rates were rather low and much the same in all treatment groups, except a higher rate of heart failure in the rosiglitazone group. These results suggest that the routine inhibition of the renin-angiotensin system for the express purpose of preventing diabetes is not indicated in individuals not at high risk for cardiovascular disease and appear to confirm the promises of the glitazone use in the very early stage of the natural history of type 2 diabetes. [less ▲]

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See detailL'etude clinique du mois. L'etude EUROPA: protection cardio-vasculaire avec le perindopril chez les patients avec coronaropathie stable.
Scheen, André ULg; Legrand, Victor ULg

in Revue Médicale de Liège (2003), 58(11), 713-6

The multicentre placebo-controlled double-blind "EUropean trial on Reduction Of cardiac events with Perindopril in patients with stable coronary Artery disease" (EUROPA) assessed whether the angiotensin ... [more ▼]

The multicentre placebo-controlled double-blind "EUropean trial on Reduction Of cardiac events with Perindopril in patients with stable coronary Artery disease" (EUROPA) assessed whether the angiotensin-converting-enzyme inhibitor perindopril reduces cardiovascular risk in a population with stable coronary heart disease and no apparent heart failure, whatever the associated cardiovascular risk. Patients were randomly assigned perindopril 8 mg once daily (n = 6110) or matching placebo (n = 6108). After a mean follow-up of 4.2 years, a relative risk reduction of 20% (95% CI 9-29, p = 0.0003) was observed in the combined primary endpoint (cardiovascular death, myocardial infarction, or cardiac arrest) in the group treated with perindopril as compared to placebo. About 50 patients needed to be treated for a period of 4 years to prevent one major cardiovascular event. This benefit was consistent in all predefined subgroups. According to these results, treatment with perindopril, on top of other preventive medications, should be considered in all patients with stable coronary heart disease. [less ▲]

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See detailL'etude clinique du mois. L'etude FIELD de protection cardio-vasculaire avec le fenofibrate chez le patient diabetique de type 2.
Radermecker, Régis ULg; Scheen, André ULg

in Revue Médicale de Liège (2005), 60(12), 957-61

FIELD ("Fenofibrate Intervention and Events Lowering in Diabetes") study compared the incidence of coronary and cardiovascular events in 4895 patients with type 2 diabetes treated with fenofibrate ... [more ▼]

FIELD ("Fenofibrate Intervention and Events Lowering in Diabetes") study compared the incidence of coronary and cardiovascular events in 4895 patients with type 2 diabetes treated with fenofibrate (micronized fomulation, 200 mg/day) and in 4900 patients treated with placebo. After a mean 5-year follow-up, the fenofibrate group did not have less coronary events (primary endpoint), neither present a significant reduction in cardiovascular or total mortality as compared to the placebo group. However, it had significantly less non-fatal myocardial infarctions and cardiovascular events in general as well as less coronary and total revascularization procedures (secondary endpoints). The higher rate of starting statin therapy in patients allocated placebo might have masked a larger treatment benefit of fenofibrate on macrovascular complications. The tolerance of fenofibrate was good, even in combination with statins. More surprisingly, fenofibrate exerted a favourable effect on microangiopathy complications, with less albuminuria progression and less retinopathy needing laser treatment (tertiary endpoints). [less ▲]

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See detailL'etude clinique du mois. L'etude HOPE, un essai clinique bicephale aux resultats contrastes.
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(2), 121-4

The results of the HOPE ("Heart Outcomes Prevention Evaluation") study, recently published in the New England Journal of Medicine, demonstrated a highly significant cardiovascular protection by an ... [more ▼]

The results of the HOPE ("Heart Outcomes Prevention Evaluation") study, recently published in the New England Journal of Medicine, demonstrated a highly significant cardiovascular protection by an angiotensin converting enzyme inhibitor, ramipril at a dose of 10 mg/day, after a mean follow-up of 4.5 years, but not of vitamin E supplements at a dose of 400 UI/day in high-risk patients (> 55 years old) who had evidence of vascular disease (secondary prevention) or combined diabetes mellitus and another cardiovascular risk factor (primary prevention). [less ▲]

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See detailL'etude clinique du mois. L'etude IDEAL comparant simvastatine 20-40 mg versus atorvastatine 80 mg en prevention apres un infarctus du myocarde: entre deux idees de l'ideal.
Scheen, André ULg

in Revue Médicale de Liège (2006), 61(1), 53-9

The IDEAL ("Incremental Decrease in End Points Through Aggressive Lipid Lowering") study compared the effects of two strategies of lipid lowering on the risk of cardiovascular disease among patients with ... [more ▼]

The IDEAL ("Incremental Decrease in End Points Through Aggressive Lipid Lowering") study compared the effects of two strategies of lipid lowering on the risk of cardiovascular disease among patients with a previous myocardial infarction. In this prospective, randomized, open-label, blinded end-point evaluation trial, patients were randomly assigned to receive a high dose of atorvastatin (80 mg/day; n = 4439), or an usual dose of simvastatin (20 mg/day, titrated up to 40 mg/day if necessary; n = 4449). During treatment, mean LDL cholesterol levels were 104 mg/dl in the simvastatin group and 81 mg/dl in the atorvastatin group (p < 0.001). After a median follow-up of 4.8 years, no significant difference was observed in the primary outcome of major coronary events (defined as coronary death, confirmed nonfatal acute myocardial infarction, or cardiac arrest with resuscitation), but the risk of other composite secondary end points (i.e., major cardiovascular events, all cardiovascular events, all coronary events) was statistically reduced in the atorvastatin group compared to the simvastatin group. There were no differences in cardiovascular or all-cause mortality between the two groups. In conclusion, patients with myocardial infarction may benefit from intensive lowering of LDL cholesterol without an increase in noncardiovascular mortality or other serious adverse reactions. [less ▲]

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See detailL'etude clinique du mois. L'etude LIFE: protection cardio-vasculaire du patient hypertendu par le losartan.
Scheen, André ULg

in Revue Médicale de Liège (2002), 57(4), 240-4

The LIFE study ("Losartan Intervention For Endpoint reduction in hypertension study") demonstrated a significant cardiovascular protection by an angiotensin AT1 receptor antagonist, losartan, in ... [more ▼]

The LIFE study ("Losartan Intervention For Endpoint reduction in hypertension study") demonstrated a significant cardiovascular protection by an angiotensin AT1 receptor antagonist, losartan, in hypertensive patients with left ventricular hypertrophy. At similar blood pressure control, losartan, as compared to atenolol, reduced the relative risk of primary cardiovascular event (death, myocardial infarction, or stroke) by 13% (p = 0.021) in the whole cohort of 9.193 patients after a mean follow-up of 4.7 years. In a subgroup of 1.195 diabetic patients, the protection was even more marked with a reduction of the combined risk of 24% (p = 0.031) and a fall of the mortality of 39% (p = 0.002). In conclusion, losartan prevents cardiovascular morbidity and death more effectively than atenolol, and seems to confer benefits beyond reduction in blood pressure. [less ▲]

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See detailL'etude clinique du mois. L'etude LIPID: "long-term intervention withpravastatin in ischaemic disease".
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(1), 2-3

The LIPID study is a placebo-controlled, double-bind, randomized trial, performed in 9014 patients with coronary heart disease and total cholesterol levels of 155 to 271 mg/dl. After a mean follow-up of 6 ... [more ▼]

The LIPID study is a placebo-controlled, double-bind, randomized trial, performed in 9014 patients with coronary heart disease and total cholesterol levels of 155 to 271 mg/dl. After a mean follow-up of 6.1 years, patients receiving pravastatin (40 mg/day) had significantly (p < 0.001) lower death rate from coronary heart disease (24%), lower overall mortality (22%) and lower incidence of all cardiovascular outcomes (20 to 29% depending on the event). Interestingly enough, the reduction in death from coronary heart disease or nonfatal myocardial infarction was observed whatever the initial cholesterol concentration, and already significant if total cholesterol was < 213 mg/dl and LDL cholesterol was < 135 mg/dl. Thus, in secondary prevention, the favourable effect of the statin on the coronary heart disease outcomes is observed even in case of initial cholesterol levels yet considered as "normal". [less ▲]

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See detailL'etude clinique du mois. L'etude LIPS: prevention par la fluvastatine des accidents cardiaques apres angioplastie coronaire percutanee.
Scheen, André ULg

in Revue Médicale de Liège (2002), 57(7), 479-82

The prospective placebo-controlled LIPS study ("Lescol Intervention Prevention Study") demonstrated a significant cardiovascular protection by fluvastatin in patients with coronary artery disease (stable ... [more ▼]

The prospective placebo-controlled LIPS study ("Lescol Intervention Prevention Study") demonstrated a significant cardiovascular protection by fluvastatin in patients with coronary artery disease (stable or unstable angina, silent ischemia), without major hypercholesterolaemia (135-270 mg/dl) following successful completion of their first percutaneous coronary intervention. When compared to the placebo group (n = 833), the fluvastatin group (n = 844) showed a relative risk reduction by 22% (relative risk: 0.78; 95% confidence interval: 0.64-0.95; p = 0.01) of major adverse cardiac events after a median time of follow-up of 3.9 years. This effect is observed independently of baseline total cholesterol, of the presence of diabetes mellitus or the existence of multivessel disease. These results suggest that fluvastatin may favorably influence the restenosis process after percutaneous coronary intervention, even in the absence of severe hypercholesterolaemia. [less ▲]

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See detailL'etude clinique du mois. L'etude PROSPER (PROspective study of pravastatin in the elderly at risk).
Kulbertus, Henri ULg; Scheen, André ULg

in Revue Médicale de Liège (2002), 57(12), 809-13

Statins reduce coronary and cerebrovascular mortality and morbidity in middle-aged individuals. Until recently, their efficacy and safety in elderly people had not yet been firmly established. PROSPER was ... [more ▼]

Statins reduce coronary and cerebrovascular mortality and morbidity in middle-aged individuals. Until recently, their efficacy and safety in elderly people had not yet been firmly established. PROSPER was a controlled, randomised study involving 2,804 men and 3,000 women aged 70-82, with a history of, or risk factors for cardiovascular disease. Their baseline cholesterol level was 135-350 mg/dl; they were randomised to either 40 mg pravastatin per day, or matching placebo. Average follow-up was 3.2 years. The primary endpoint was a composite of coronary death, non-fatal myocardial infarction, and fatal or non-fatal stroke. Pravastatin lowered LDL-cholesterol (-34%), and reduced the incidence of the primary endpoint (-15%; CI 95%: 3-26%; p = 0.014). Coronary death and non-fatal myocardial infarction risk was also reduced (-19%; p = 0.006), and mortality from coronary disease fell by 24% (p = 0.043). The risk for stroke, however, was unaffected (p = 0.8), whereas the incidence of transient ischemic attacks was reduced by 25%, which was (marginally) insignificant (p = 0.051). Pravastatin had no effect on cognitive functions or incapacity. New cancers were more frequent amongst pravastatin-treated individuals (+25%; p = 0.020). However incorporation of this new data in a meta-analysis of all pravastatin and all statin trials revealed no overall increase of cancer risk. [less ▲]

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See detailL'etude clinique du mois. L'etude Steno-2: plaidoyer pour une prise en charge globale et intensive du patient diabetique de type 2.
Scheen, André ULg; Estrella, F.

in Revue Médicale de Liège (2003), 58(2), 109-11

Cardiovascular morbidity is a major burden in patients with type 2 diabetes. The Steno-2 Study compared the effect of a targeted, intensified, multifactorial intervention (n = 80) with that of a ... [more ▼]

Cardiovascular morbidity is a major burden in patients with type 2 diabetes. The Steno-2 Study compared the effect of a targeted, intensified, multifactorial intervention (n = 80) with that of a conventional treatment (n = 80) on modifiable risk factors for cardiovascular disease in patients with type 2 diabetes and microalbuminuria. After a mean follow-up of 7.8 years, the risk of cardiovascular events was reduced by 53% in the intensive group, and the risk of microvascular events (nephropathy, retinopathy, autonomic neuropathy) by 58-63%. Thus, a target-driven, long-term, intensified intervention aimed at multiple risk factors should be recommended in patients with type 2 diabetes and microalbuminuria. [less ▲]

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See detailL'etude clinique du mois. L'etude STOP-2 dans l'hypertension arterielle du sujet age.
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(1), 64-6

After the demonstration of the efficacy of beta-blockers or diuretics versus placebo to prevent cardiovascular complications in elderly hypertensive patients in the first STOP-Hypertension study in 1991 ... [more ▼]

After the demonstration of the efficacy of beta-blockers or diuretics versus placebo to prevent cardiovascular complications in elderly hypertensive patients in the first STOP-Hypertension study in 1991, a Swedish group published at the end of 1999 the STOP-2 Hypertension study. The latter randomised trial showed in a similar population that the cardiovascular protection of more recent antihypertensive agents such as calcium antagonists and angiotensin-converting-enzyme inhibitors is similar to that of the conventional antihypertensive drugs used in the first study. In fact, the degree of blood pressure control appears to be more important than the type of antihypertensive drugs used, and this conclusion is reinforced by the observation that numerous patients should rapidly be treated by more than one antihypertensive agent to reach blood pressure targets. [less ▲]

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See detailL'etude clinique du mois. L'etude TORCH (TOwards a Revolution in COPD Health): vers une revolution de la sante des patients souffrant de BPCO
Corhay, Jean-Louis ULg; Louis, Renaud ULg

in Revue Médicale de Liège (2007), 62(4), 230-4

The TORCH study (Towards a Revolution in COPD Health) was a double-blind, randomised, placebo-controlled clinical trial, investigating the combination of salmeterol/fluticasone propionate for 3 years in ... [more ▼]

The TORCH study (Towards a Revolution in COPD Health) was a double-blind, randomised, placebo-controlled clinical trial, investigating the combination of salmeterol/fluticasone propionate for 3 years in COPD. The primary end point was on all-cause mortality. Secondary end points included COPD exacerbation rate, lung function and health status. More than 6000 patients were randomised. In this article, we briefly report the most significant results of the study. The efficacy on mortality (reduction of the risk of death of 17.5%) was near the predetermined level of statistical significance (p = 0.052); the combination had a significant effect on the three pillars of COPD management, that is: improvement of quality of life and respiratory function, and reduction of the rate of exacerbations. In addition to being effective, the combination salmeterol/fluticasone (50/500 microg 2x/day) is well tolerated in COPD and had a favourable benefit/risk ratio. [less ▲]

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