Nine-Year Effects of 3.7 Years of Intensive Glycemic Control on Cardiovascular Outcomes
Nine-Year Effects of 3.7 Years of Intensive Glycemic Control on Cardiovascular Outcomes
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DOI：
10.2337/dc15-2283
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发表时间：
2016-05-01
期刊：
影响因子：
16.2
通讯作者：
Friedewald, William T.
中科院分区：
文献类型：
--
作者：
Gerstein, Hertzel C.;Beavers, Daniel P.;Friedewald, William T.
目的：在控制糖尿病心血管风险的行动(ACCORD)试验中，对伴有其他心血管危险因素的2型糖尿病患者进行为期4年的强化血糖控制与标准血糖控制相似，对综合心血管结局、增加心血管死亡率和总死亡率以及减少非致命性心肌梗死的影响为中性。对长期随访期间干预的效果进行分析。研究设计和方法所有幸存的ACCORD参与者被邀请参加ACCORD随访(手风琴)研究，在此期间，参与者根据他们的卫生保健提供者的判断进行治疗。根据参与者最初被分配到的组，前瞻性地收集和分析心血管和其他与健康相关的结果。结果总共监测了8,601人，占在ACCORD试验期间没有遭受主要结果或死亡的人的98%，监测的中位数为8.8年，随机后的平均时间为7.7年。平均3.7年的强化降糖对主要综合结果(非致命性心肌梗死、非致命性中风或心血管死亡)、任何原因的死亡以及包括所有原因死亡的扩展综合结果具有中性的长期影响。此外，活动期的心血管死亡风险(危险比1.49；95%CI 1.19，1.87；P<；0.0001)降低(HR 1.2 0；95%CI 1.03，1.39；P=0.0 2)。结论在监测9年的2型糖尿病高危人群中，平均3.7年的强化血糖控制对死亡和非致命性心血管事件有中性影响，但增加了心血管相关死亡。
OBJECTIVEIn the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, similar to 4 years of intensive versus standard glycemic control in participants with type 2 diabetes and other cardiovascular risk factors had a neutral effect on the composite cardiovascular outcome, increased cardiovascular and total mortality, and reduced nonfatal myocardial infarction. Effects of the intervention during prolonged follow-up were analyzed.RESEARCH DESIGN AND METHODSAll surviving ACCORD participants were invited to participate in the ACCORD Follow-on (ACCORDION) study, during which participants were treated according to their health care provider's judgment. Cardiovascular and other health-related outcomes were prospectively collected and analyzed using an intention-to-treat approach according to the group to which participants were originally allocated.RESULTSA total of 8,601 people, representing 98% of those who did not suffer a primary outcome or death during the ACCORD trial, were monitored for a median of 8.8 years and a mean of 7.7 years from randomization. Intensive glucose lowering for a mean of 3.7 years had a neutral long-term effect on the primary composite outcome (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death), death from any cause, and an expanded composite outcome that included all-cause death. Moreover, the risk of cardiovascular mortality noted during the active phase (hazard ratio 1.49; 95% CI 1.19, 1.87; P < 0.0001) decreased (HR 1.20; 95% CI 1.03, 1.39; P = 0.02).CONCLUSIONSIn high-risk people with type 2 diabetes monitored for 9 years, a mean of 3.7 years of intensive glycemic control had a neutral effect on death and nonfatal cardiovascular events but increased cardiovascular-related death.