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.
Browsing: Cardiovascular
Cardiovascular outcomes, heart failure, cardio-renal protection, hypertension, and lipid-lowering trials in diabetes and endocrinology.
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.
ADVANCE demonstrated that intensive glucose control targeting HbA1c below 6.5% using a gliclazide-based strategy reduces nephropathy by 21% and the microvascular composite by 14% in high-risk type 2 diabetes, without the mortality hazard observed in ACCORD, providing important context for how glycaemic targets and treatment strategies interact with safety outcomes.
ACCORD demonstrated that targeting an HbA1c below 6.0% in high-risk type 2 diabetes patients with established cardiovascular disease increased all-cause mortality by 22% without significantly reducing cardiovascular events, establishing that very intensive glycaemic targets are harmful in this population and reshaping international guidelines to mandate individualised HbA1c targeting.
Steno-2 demonstrated that intensive multifactorial risk factor intervention targeting glycaemia, blood pressure, lipids, and lifestyle simultaneously reduces all-cause mortality by 46% and cardiovascular events by 59% over 13.3 years in type 2 diabetes with microalbuminuria, providing the defining evidence for comprehensive cardiovascular risk management in high-risk type 2 diabetes.
UKPDS 38 demonstrated that tight blood pressure control targeting below 150/85 mmHg reduces stroke by 44%, diabetes-related endpoints by 24%, and microvascular complications by 37% in hypertensive type 2 diabetes over 8.4 years, establishing blood pressure control as a therapeutic target of at least equal macrovascular importance to glycaemic management.
UKPDS 34 demonstrated that metformin reduces diabetes-related endpoints, death, and all-cause mortality by 32–42% in overweight patients with newly diagnosed type 2 diabetes, with superior cardiovascular outcomes compared with sulphonylurea or insulin, establishing metformin as the preferred first-line pharmacological therapy for type 2 diabetes for the subsequent three decades.
The EDIC study demonstrated that 6.5 years of intensive glycaemic therapy during the DCCT reduced cardiovascular events by 42–57% over 17 years of follow-up despite subsequent HbA1c convergence between groups, establishing the concept of metabolic memory and providing foundational evidence that early intensive glycaemic control produces durable cardiovascular protection extending decades beyond the intervention period.
An RCT finds adding Tai Chi to time-restricted eating improves lipids and endothelial function in postmenopausal women. PICO summary and expert commentary for clinicians.
An RCT finds combining exercise with broccoli sprout supplementation improves apolipoproteins in type 2 diabetes, mainly driven by exercise. PICO summary and expert commentary.