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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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See detailL'etude clinique du mois. La MRC/BHF Heart Protection Study.
Kulbertus, Henri ULg; Scheen, André ULg

in Revue Médicale de Liège (2002), 57(9), 613-6

20,536 adults (15,454 men and 5,082 women, aged 40-80 years) with coronary heart disease, other occlusive arterial disease or diabetes mellitus were randomly allocated to receive 40 mg simvastatin daily ... [more ▼]

20,536 adults (15,454 men and 5,082 women, aged 40-80 years) with coronary heart disease, other occlusive arterial disease or diabetes mellitus were randomly allocated to receive 40 mg simvastatin daily or matching placebo. In addition to being randomized to compare simvastatin vs placebo, all patients were also randomized to compare antioxidant vitamin supplementation (vitamin E 600 mg/day, vitamin C 250 mg/day and betacarotene 20 mg/day) vs placebo in a "2 x 2 factorial" design. Duration of the study was 5 years. All-cause mortality was significantly reduced among patients allocated to simvastatin (-12.3%) due to a highly significant (-18%) reduction in the coronary death rate, a marginally significant reduction in other vascular deaths and a non-significant reduction in non-vascular deaths. There were highly significant reductions (of about one-quarter) in the first event rate for non-fatal myocardial infarction and coronary death (combined), for non-fatal and fatal stroke and for coronary or non-coronary revascularization. The beneficial effect of simvastatin was seen in all sub-categories which were studied and, particularly: women vs men; patients aged > 70 years vs those aged < 70 years; patients with LDL cholesterol < vs > 116 mg/dl, or total cholesterol < vs > 193 mg/dl. The treatment was well tolerated and the annual risk of myopathy was 0.01%. All comparisons between antioxidant vitamin supplementation and placebo failed to reveal any difference in favour or against the supplementation which was otherwise well tolerated. These important results and their implications will be briefly discussed. [less ▲]

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See detailL'etude clinique du mois. La privation chronique de sommeil predispose-t-elle au syndrome plurimetabolique?
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(11), 898-900

According to a recent experimental study published in the Lancet, sleep debt, frequently imposed by the life habits of industrialized countries, results in profound metabolic (impaired glucose tolerance ... [more ▼]

According to a recent experimental study published in the Lancet, sleep debt, frequently imposed by the life habits of industrialized countries, results in profound metabolic (impaired glucose tolerance) and endocrine (increased sympathetic activity and evening cortisol levels) alterations, which mimic those of normal ageing and may have pathophysiological consequences in the long term. Another study recently published in the International Journal of Obesity demonstrated a significant positive relationship between the duration of shift-work and body mass index or waist to hip ratio, a marker of visceral adiposity. One may thus hypothesize that chronic sleep deprivation could predispose to the metabolic syndrome and increase the cardiovascular risk. [less ▲]

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See detailL'etude clinique du mois. NAVIGATOR: essai de prevention des complications cardio-vasculaires et du diabete de type 2 par le valsartan et/ou le nateglinide.
Scheen, André ULg

in Revue Médicale de Liège (2010), 65(4), 217-23

NAVIGATOR ("Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research") is a large international placebo-controlled trial that randomised 9,031 individuals at high risk because of impaired ... [more ▼]

NAVIGATOR ("Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research") is a large international placebo-controlled trial that randomised 9,031 individuals at high risk because of impaired glucose tolerance and established cardiovascular disease or cardiovascular risk factors. This trial aimed at investigating whether valsartan (a selective AT1 receptor antagonist) and/or nateglinide (a short-acting insulin-secreting agent) are able to reduce the incidence of type 2 diabetes and cardiovascular events. After a median follow up of 6.5 years, neither valsartan nor nateglinide improved cardiovascular prognosis in the tested population, which already benefited from a protective pharmacotherapy at baseline and a reinforcement of lifestyle modification throughout the trial. Nateglinide did not diminish the risk of new onset diabetes. In contrast, valsartan reduced the incidence of type 2 diabetes by 14%, confirming the potential interest of the blockade of the renin-angiotensin system in this high-risk population. [less ▲]

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See detailEtude clinique du mois. ONTARGET: protection comparable du telmisartan et du ramipril et absence de benefice de la combinaison chez des patients a haut risque vasculaire.
Scheen, André ULg; Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (2008), 63(4), 213-9

ONTARGET ("ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial") compared the angiotensin converting enzyme inhibitor ramipril (10 mg/day), the angiotensin-receptor blocker ... [more ▼]

ONTARGET ("ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial") compared the angiotensin converting enzyme inhibitor ramipril (10 mg/day), the angiotensin-receptor blocker telmisartan 80 mg/day, and the combination of the two drugs in 25,620 patients with vascular disease or high-risk diabetes. After a median follow up of 56 months, no significant differences were observed between the three groups neither in the primary composite outcome (death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure), nor in each of its components, total mortality and other secondary outcomes. Telmisartan was equivalent to ramipril (non inferiority criterion), but was better tolerated (less cough and angioedema). The combination of the two drugs in this population (without congestive heart failure and proteinuric nephropathy) did not bring increased benefit (no superiority), but was associated with more adverse events (hypotension, syncope and renal dysfunction). In this population, the choice of the molecule in monotherapy remains optional and the use of a dual blockade is not justified in order to have a better cardiovascular protection. [less ▲]

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See detailL'etude clinique du mois. Prevention des accidents vasculaires cerebraux chez les patients avec fibrillation auriculaire.
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(6), 561-3

A recent analysis of the literature, published in the 19 May issue of the JAMA, once again demonstrates the efficacy of warfarin, and its superiority on aspirin, in preventing stroke in patients with ... [more ▼]

A recent analysis of the literature, published in the 19 May issue of the JAMA, once again demonstrates the efficacy of warfarin, and its superiority on aspirin, in preventing stroke in patients with atrial fibrillation, at least in subjects at highest risk. However, a feasibility study, published in the 15 May issue of the British Medical Journal, points to the difficulties of implementing guidelines from evidence-based medicine in general practice, essentially because of the reluctance of the physician and/or the patient when the constraints, risks and even advantages of antithrombotic treatment are taken into account. [less ▲]

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See detailL'etude clinique du mois. Prevention du diabete de type 2 chez le sujet avec exces ponderal et diminution de la tolerance au glucose: efficacite des mesures hygieno-dietetiques.
Scheen, André ULg

in Revue Médicale de Liège (2001), 56(6), 463-5

The "Finnish Diabetes Prevention Study" is a prospective controlled study recently published in the New England Journal of Medicine which compared the risk of developing type 2 diabetes among 265 high ... [more ▼]

The "Finnish Diabetes Prevention Study" is a prospective controlled study recently published in the New England Journal of Medicine which compared the risk of developing type 2 diabetes among 265 high-risk patients treated by changes in lifestyle to that of 257 matched controlled patients. This intervention trial demonstrated that the risk of type 2 diabetes could be reduced by 58% (p < 0.001) after a mean follow-up of 3.2 years with changes in lifestyle of high-risk overweight subjects with impaired glucose tolerance. [less ▲]

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See detailEtude clinique du mois. Protection secondaire de l'accident vasculaire cerebral par le perindopril: l'etude PROGRESS.
Scheen, André ULg

in Revue Médicale de Liège (2001), 56(11), 792-5

PROGRESS ("Perindopril pROtection aGainst REcurrent Stroke Study") demonstrated that blood-pressure lowering treatment with perindopril, an angiotensin converting enzyme inhibitor (combined with the ... [more ▼]

PROGRESS ("Perindopril pROtection aGainst REcurrent Stroke Study") demonstrated that blood-pressure lowering treatment with perindopril, an angiotensin converting enzyme inhibitor (combined with the diuretic agent indapamide when necessary), reduces the risk of stroke by 28% (95% CI: 17-38, p < 0.0001) among patients with a history of stroke or transient ischaemic attack. This protective effect was observed among both hypertensive and non-hypertensive individuals. It was more marked in the patients receiving combined perindopril + indapamide treatment (-43%; 95% CI 30-54) who were those who showed the greatest reduction in arterial blood pressure (-12/5 mm Hg). According to these observations, the authors concluded that treatment with these two agents should now be considered routinely for patients with a history of stroke or transient ischaemic attack, irrespective of their blood pressure. [less ▲]

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See detailEtude clinique du mois. Radio-chimiotherapie et chimiotherapie adjuvante apres resection a visee curative du cancer du pancreas: resultats de l'etude randomisee ESPAC-1
Polus, Marc ULg; Jerusalem, Guy ULg; Sautois, Brieuc ULg et al

in Revue Médicale de Liège (2002), 57(2), 119-22

The prognosis of pancreatic adenocarcinoma remains poor, with a 5-year survival rate lower than 5%. Resection, the gold standard treatment, can be performed in less than 15% of patients. Following surgery ... [more ▼]

The prognosis of pancreatic adenocarcinoma remains poor, with a 5-year survival rate lower than 5%. Resection, the gold standard treatment, can be performed in less than 15% of patients. Following surgery, the median survival is 12 months for the most favourable cancer patients. Adjuvant treatment have attempted to improve results. However, chemotherapy, radiotherapy and multimodal treatments don't have demonstrated a clear advantage in controlled trials. We will discuss results of the current trials in this topic. The randomised trial of the European Study Group for Pancreatic Cancer (ESPAC) recently published in the Lancet revealed a potential benefit of adjuvant chemotherapy. A critical analysis of the publication showed, however, that definitive conclusions of this trial must be interpreted with caution. [less ▲]

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See detailL'etude clinique du mois. REVERSAL et PROVE-iT: confirmation du concept the lower, the better" dans le traitement de l'hypercholesterolemie chez le patient coronarien."
Scheen, André ULg; Kulbertus, Henri ULg

in Revue Médicale de Liège (2004), 59(3), 167-73

Statins, as compared to placebo, have proven their efficacy in reducing cardiovascular events in patients with or without cardiovascular disease and in a large range of cholesterol levels. Two new head-to ... [more ▼]

Statins, as compared to placebo, have proven their efficacy in reducing cardiovascular events in patients with or without cardiovascular disease and in a large range of cholesterol levels. Two new head-to-head randomised trials comparing intensive treatment with atorvastatin 80 mg/day with moderate treatment with pravastatin 40 mg/day were recently completed. The mechanistic "Reversing Atherosclerosis with Aggressive Lipid Lowering" (REVERSAL) trial randomised 502 patients with stable coronary disease. Atorvastatin 80 mg (leading to a mean LDL cholesterol of 79 mg/dl) was superior to pravastatin 40 mg (mean LDL of 110 mg/dl) in terms of limiting the progression of atheroma assessed with the use of intravascular ultrasonography after 18 months of follow up (p = 0.02). These differences may be related to the greater reduction in atherogenic lipoprotein (-46% versus -26%, p < 0.001) and C-reactive protein (-36% versus -5%, p < 0.001) in patients treated with atorvastatin as compared to pravastatin. In the clinical "Pravastatin or Atorvastatin Evaluation and Infection Therapy" (PROVE-IT) trial, 4162 patients with acute coronary syndromes were randomised to either atorvastatin 80 mg or pravastatin 40 mg and followed for a mean of 24 months. Again, atorvastatin (mean LDL of 62 mg/dl) was superior to pravastatin (mean LDL of 95 mg/dl), resulting in a 16% percent lower risk of the primary end point, a composite of major cardiovascular events (p = 0.005). Thus, both REVERSAL and PROVE-IT support the concept "the lower, the better". However, they do not allow to disentangle the independent and interdependent effects of statins on LDL cholesterol and the process of arterial inflammation. What so ever, the results suggest that the target LDL cholesterol level may be lower than recommended in the current guidelines in high-risk patient so that a sea change in the prevention and management of atherosclerotic vascular disease may occur very soon. [less ▲]

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See detailEtude clinique du mois. Rôle néphroprotecteur des antagonistes du récepteur de l'angiotensine II (ARA) dans le diabète de type 2: résultats des études IDNT et RENAAL
Weekers, Laurent ULg; Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (2001), 56(10), 723-726

Nephropathy associated with type 2 diabetes mellitus is a rising cause of end-stage renal disease and is a major public health problem. If blocking of the renin angiotensin system has a well established ... [more ▼]

Nephropathy associated with type 2 diabetes mellitus is a rising cause of end-stage renal disease and is a major public health problem. If blocking of the renin angiotensin system has a well established nephroprotective effect in type 1 diabetic nephropathy, this remained to be shown for type 2 diabetes. Two large outcome trials using angiotensin II receptor antagonists (ARA's) in proteinuric chronic renal impairment and hypertensive type 2 diabetic patients have now closed this gap: the Irbesartan Diabetic Nephropathy Trial (IDNT) and the Reduction of Endpoints in NIDDM with Angiotensin II Antagonist Losartan (RENAAL) trial. Both trials showed a significant reduction in the primary pre-specified end-point of death, or worsening of renal function (doubling of serum creatinine) or the development of end-stage renal disease. This effect goes beyond the reduction in blood pressure and makes of ARA's one of the important tools in the treatment of type 2 diabetic nephropathy. [less ▲]

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See detailL'etude clinique du mois. Toxicite de l'hyperglycemie en soins intensifs et effets benefiques d'une insulinotherapie optimisee.
Scheen, André ULg

in Revue Médicale de Liège (2001), 56(12), 859-61

A large Belgian, prospective, controlled study was performed in 1.548 critically ill patients (83% without history of diabetes) hospitalised in a surgical intensive care unit. On admission, patients were ... [more ▼]

A large Belgian, prospective, controlled study was performed in 1.548 critically ill patients (83% without history of diabetes) hospitalised in a surgical intensive care unit. On admission, patients were randomly assigned to receive intensive intravenous insulin therapy (maintenance of blood glucose at a level between 80 and 110 mg/dl) or conventional treatment (infusion of insulin only if the blood glucose level exceeded 215 mg/dl and maintenance of glucose at a level between 180 and 200 mg/dl). Intensive insulin therapy reduced morbidity and mortality by 40%. These remarkable results should influence further therapeutical attitudes in intensive care units and open new perspectives for the management of critically ill patients. [less ▲]

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See detailL'etude clinique du mois. Treating to New Targets": plaidoyer pour une valeur cible de cholesterol LDL egale ou inferieure a 75 mg/dl chez tout patient coronarien."
Scheen, André ULg

in Revue Médicale de Liège (2005), 60(4), 264-7

The "Treating to New Targets" (TNT) trial compared atorvastatin 80 mg (aiming at reducing LDL cholesterol < or = 75 mg/dl) and atorvastatin 10 mg (LDL < or = 100 mg/dl as target) in 10,001 patients with ... [more ▼]

The "Treating to New Targets" (TNT) trial compared atorvastatin 80 mg (aiming at reducing LDL cholesterol < or = 75 mg/dl) and atorvastatin 10 mg (LDL < or = 100 mg/dl as target) in 10,001 patients with stable coronary heart disease followed up for 5 years. A reduction of major cardiovascular events of 22% was observed in the atorvastatin 80 mg group as compared to the atorvastatin 10 mg group (hazard ratio: 0.78; 95 % interval of confidence: 0.69-0.89; p < 0.001). Such clinical efficacy was obtained while a good drug safety profile was maintained. Total mortality was not significantly different between the two groups. However, and remarkably, cardiovascular death was not the first cause of death anymore in this atorvastatin-treated population. The results of TNT in patients with stable coronary heart disease thus confirm the results of PROVE-IT in patients with acute coronary syndrome. These two randomised controlled trials should encourage considering a LDL cholesterol level of 75 mg/dl (rather than 100 mg/dl) as a new target in any patient with coronary heart disease. [less ▲]

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