Journal
DIABETES RESEARCH AND CLINICAL PRACTICE
Volume 98, Issue 1, Pages 83-90Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.diabres.2012.05.002
Keywords
ADVANCE trial; Blood pressure; Diabetes mellitus; Cardiovascular disease; Coronary heart disease; Framingham; Mortality; Risk groups; Risk scores; Type 2 diabetes
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Funding
- CTMM, the center for Translational Molecular Medicine, project PREDICCt [01C-104]
- Netherlands Heart Foundation
- Dutch Diabetes Research Foundation
- Dutch Kidney Foundation
- EFSD/sanovi-aventis
- Servier
- National Health and Medical Research Council of Australia
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Aims: To asses differences in treatment effects of a fixed combination of perindopril-indapamide on major clinical outcomes in patients with type 2 diabetes across subgroups of cardiovascular risk. Methods: 11,140 participants with type 2 diabetes, from the ADVANCE trial, were randomized to perindopril-indapamide or matching placebo. The Framingham equation was used to calculate 5-year CVD risk and to divide participants into two risk groups, moderate-high risk (<25% and no history of macrovascular disease), very high risk (>25% and/or history of macrovascular disease). Endpoints were macrovascular and microvascular events. Results: The mean age of participants was 66 years (42.5% female). 1000 macrovascular and 916 microvascular events were recorded over follow-up of 4.3 years. Relative treatment effects were similar across risk groups, (all P-values for heterogeneity >= 0.38). Hazard ratios for combined macro-and microvascular events were 0.89 (0.77-1.03) for the moderate-high risk and 0.92 (0.81-1.03) for the very high risk. Absolute treatment effects tended to be greater in the high risk groups although differences were not statistically significant (P > 0.05). Conclusions: Relative effects of blood pressure lowering with perindopril-indapamide on cardiovascular outcomes were similar across risk groups whilst absolute effects trended to be greater in the high risk group. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
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