Cardiovascular outcome evidence in diabetes and metabolism, including MACE, heart failure, renal outcomes, lipid therapy, hypertension, and cardiometabolic risk reduction.
In high-risk type 2 diabetes, once-daily oral semaglutide 14 mg cut major adverse cardiovascular events versus placebo in the SOUL trial, with no kidney benefit shown. PICO summary and expert commentary.
A post-hoc ACCORD-BP analysis of 307 patients with type 2 diabetes and prior stroke links intensive SBP control below 120 mmHg to lower MACE risk. PICO summary and expert commentary.
An EXSCEL post hoc simulation and mediation analysis showing conventional risk-factor changes explain only a modest share of once-weekly exenatide's cardiovascular effects. PICO summary and expert commentary.
A post-hoc analysis of the SPRINT trial finds a higher triglyceride-glucose index is associated with greater cardiovascular risk in controlled hypertension, significant only under standard blood pressure treatment. PICO summary and expert commentary.
A secondary lipidomic analysis of two randomized crossover feeding trials found that lowering dietary saturated fat reshaped the lipoprotein(a) lipidome while plasma Lp(a) rose. PICO summary and expert commentary.
CARDS demonstrated that atorvastatin 10 mg reduces major cardiovascular events by 37% and stroke by 48% in patients with type 2 diabetes and normal to mildly elevated LDL-cholesterol without prior CVD, confirming that cardiovascular risk rather than LDL level should determine statin initiation and establishing universal statin use in primary cardiovascular prevention for type 2 diabetes.
HPS demonstrated that simvastatin reduces major vascular events by 24% across all high-risk patients regardless of baseline LDL-cholesterol level, including those with diabetes without established coronary disease, eliminating the treatment threshold concept and establishing absolute cardiovascular risk as the primary criterion for statin therapy — one of the most influential results in preventive cardiology.
WOSCOPS demonstrated that pravastatin reduces the combined incidence of nonfatal MI and coronary death by 31% in men with hypercholesterolaemia and no prior MI, establishing the primary prevention indication for statin therapy and providing the first large randomised evidence for population-level lipid lowering in high-risk individuals without established cardiovascular disease.
The 4S trial demonstrated that simvastatin reduces all-cause mortality by 30%, coronary death by 42%, and major coronary events by 34% in patients with established coronary heart disease and no excess non-cardiovascular mortality, resolving the safety debate and establishing statin therapy as the standard of care in secondary cardiovascular prevention.
VADT demonstrated that intensive glucose control achieving a median HbA1c of 6.9% did not significantly reduce cardiovascular events or mortality in veterans with long-standing type 2 diabetes and high cardiovascular disease prevalence, completing the ACCORD/ADVANCE/VADT triptych that defined the limits of aggressive glycaemic management in advanced disease.
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