ORBi: McMurray John J - Effect of valsartan on the incidence of diabetes and cardiovascular events.

Reference : Effect of valsartan on the incidence of diabetes and cardiovascular events.


	Document type :	Scientific journals : Article
	Discipline(s) :	Human health sciences : Cardiovascular & respiratory systems Human health sciences : Pharmacy, pharmacology & toxicology Human health sciences : Endocrinology, metabolism & nutrition
	To cite this reference:	http://hdl.handle.net/2268/25987

Title :	Effect of valsartan on the incidence of diabetes and cardiovascular events.
Language :	English
Author, co-author :	McMurray, John J [> > > >]
	Holman, Rury R [> > > >]
	Haffner, Steven M [> > > >]
	Bethel, M Angelyn [> > > >]
	Holzhauer, Bjorn [> > > >]
	Hua, Tsushung A [> > > >]
	Belenkov, Yuri [> > > >]
	Boolell, Mitradev [> > > >]
	Buse, John B [> > > >]
	Buckley, Brendan M [> > > >]
	Chacra, Antonio R [> > > >]
	Chiang, Fu-Tien [> > > >]*
	Charbonnel, Bernard [> > > >]
	Chow, Chun-Chung [> > > >]*
	Davies, Melanie J [> > > >]
	Deedwania, Prakash [> > > >]
	Diem, Peter [> > > >]
	Einhorn, Daniel [> > > >]
	Fonseca, Vivian [> > > >]
	Fulcher, Gregory R [> > > >]
	Gaciong, Zbigniew [> > > >]
	Gaztambide, Sonia [> > > >]
	Giles, Thomas [> > > >]
	Horton, Edward [> > > >]
	Ilkova, Hasan [> > > >]
	Jenssen, Trond [> > > >]
	Kahn, Steven E [> > > >]
	Krum, Henry [> > > >]
	Laakso, Markku [> > > >]
	Leiter, Lawrence A [> > > >]
	Levitt, Naomi S [> > > >]
	Mareev, Viacheslav [> > > >]
	Martinez, Felipe [> > > >]
	Masson, Chantal [> > > >]
	Mazzone, Theodore [> > > >]
	Meaney, Eduardo [> > > >]
	Nesto, Richard [> > > >]
	Pan, Changyu [> > > >]
	Prager, Rudolf [> > > >]
	Raptis, Sotirios A [> > > >]
	Rutten, Guy E H M [> > > >]
	Sandstroem, Herbert [> > > >]
	Schaper, Frank [> > > >]
	Scheen, André [Université de Liège - ULg > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale >]
	Schmitz, Ole [> > > >]
	Sinay, Isaac [> > > >]
	Soska, Vladimir [> > > >]
	Stender, Steen [> > > >]
	Tamas, Gyula [> > > >]
	Tognoni, Gianni [> > > >]
	Tuomilehto, Jaako [> > > >]
	Villamil, Alberto S [> > > >]
	Vozar, Juraj [> > > >]
	Califf, Robert M [> > > >]
Publication date :	2010
Journal title :	New England Journal of Medicine [=NEJM]
Publisher :	Massachusetts Medical Society
Volume :	362
Issue/season :	16
Pages :	1477-90
Audience :	International
ISSN :	0028-4793
e-ISSN :	1533-4406
City :	Waltham
Country :	MA
Keywords :	[en] Angiotensin II Type 1 Receptor Blockers/adverse effects/therapeutic use ; Blood Glucose/analysis/drug effects ; Blood Pressure/drug effects ; Body Weight/drug effects ; Cardiovascular Diseases/epidemiology/mortality/prevention & control ; Cyclohexanes/therapeutic use ; Diabetes Mellitus, Type 2/epidemiology/prevention & control ; Double-Blind Method ; Drug Therapy, Combination ; Exercise ; Female ; Follow-Up Studies ; Glucose Intolerance/diet therapy/drug therapy/therapy ; Humans ; Hypoglycemic Agents/therapeutic use ; Incidence ; Male ; Middle Aged ; Phenylalanine/analogs & derivatives/therapeutic use ; Proportional Hazards Models ; Risk Factors ; Tetrazoles/adverse effects/therapeutic use ; Valine/adverse effects/analogs & derivatives/therapeutic use
Abstract :	[en] BACKGROUND: It is not known whether drugs that block the renin-angiotensin system reduce the risk of diabetes and cardiovascular events in patients with impaired glucose tolerance. METHODS: In this double-blind, randomized clinical trial with a 2-by-2 factorial design, we assigned 9306 patients with impaired glucose tolerance and established cardiovascular disease or cardiovascular risk factors to receive valsartan (up to 160 mg daily) or placebo (and nateglinide or placebo) in addition to lifestyle modification. We then followed the patients for a median of 5.0 years for the development of diabetes (6.5 years for vital status). We studied the effects of valsartan on the occurrence of three coprimary outcomes: the development of diabetes; an extended composite outcome of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, arterial revascularization, or hospitalization for unstable angina; and a core composite outcome that excluded unstable angina and revascularization. RESULTS: The cumulative incidence of diabetes was 33.1% in the valsartan group, as compared with 36.8% in the placebo group (hazard ratio in the valsartan group, 0.86; 95% confidence interval [CI], 0.80 to 0.92; P<0.001). Valsartan, as compared with placebo, did not significantly reduce the incidence of either the extended cardiovascular outcome (14.5% vs. 14.8%; hazard ratio, 0.96; 95% CI, 0.86 to 1.07; P=0.43) or the core cardiovascular outcome (8.1% vs. 8.1%; hazard ratio, 0.99; 95% CI, 0.86 to 1.14; P=0.85). CONCLUSIONS: Among patients with impaired glucose tolerance and cardiovascular disease or risk factors, the use of valsartan for 5 years, along with lifestyle modification, led to a relative reduction of 14% in the incidence of diabetes but did not reduce the rate of cardiovascular events. (ClinicalTrials.gov number, NCT00097786.)
Permalink :	http://hdl.handle.net/2268/25987
DOI :	10.1056/NEJMoa1001121
Other URL :	http://www.nejm.org
Commentary :	2010 Massachusetts Medical Society

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