Stephen P Juraschek1, Dan Wang2, John W McEvoy3, Stephen Harrap4, Katie Harris5, Giuseppe Mancia6, Michel Marre7, Bruce Neal8, Anushka Patel5, Neil R Poulter9, Bryan Williams10, John Chalmers5, Mark Woodward11, Elizabeth Selvin2. 1. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: sjurasch@bidmc.harvard.edu. 2. Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 3. Division of Cardiology and National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland. 4. The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia. 5. The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia. 6. University of Milan-Bicocca, Milan, Italy. 7. Clinique Ambroise Paré, Diabétologie-Endocrinologie, Neuilly-sur-Seine, France; Cordeliers Research Centre, Paris, France. 8. The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.; School of Public Health, Imperial College London, London, United Kingdom. 9. School of Public Health, Imperial College London, London, United Kingdom. 10. Institute of Cardiovascular Science, University College London, London, United Kingdom. 11. The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.; The George Institute for Global Health, Imperial College London, United Kingdom.
Abstract
OBJECTIVE: Observational data suggest a potential for subclinical cardiac damage from intensive blood glucose or blood pressure (BP) control, particularly in adults with very low blood glucose and BP levels. However, this has not been tested in a randomized trial. METHODS: The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Research Controlled Evaluation (ADVANCE) study was a factorial, randomized trial designed to test the effects of intensive blood glucose (hemoglobin A1c ≤6.5% versus usual care) and intensive BP (combination of perindopril-indapamide versus placebo) control on vascular events in adults with diabetes. Using mixed effects tobit models, we determined the effect of the randomized interventions on change in subclinical cardiac injury (high sensitivity cardiac troponin T [hs-cTnT]) and strain (N-terminal b-type pro natriuretic peptide [NT-proBNP]), 1 year after randomization. RESULTS: Among the 682 participants, mean age was 66.1 (SD, 6.5) years; 40% were women. Mean baseline hemoglobin A1c was 7.4% (SD, 1.5) and systolic/diastolic BP was 147 (SD,21)/81 (SD,11) mmHg. After 1 year, intensive versus standard glucose control did not significantly change hs-cTnT (1.5%; 95%CI:-4.9,8.2) or NT-proBNP (-10.3%; 95%CI: -20.2%,0.9%). Intensive versus standard BP control also did not affect hs-cTnT (-2.9%; 95%CI: -8.9,3.6), but did significantly lower NT-proBNP by 21.6% (95%CI:-30.2%,-11.9%). Changes in systolic BP at 1 year (versus baseline) were strongly associated with NT-proBNP (P = 0.004), but not hs-cTnT (P = 0.95). CONCLUSIONS: In adults with diabetes, intensive BP control reduced NT-proBNP without increasing hs-cTnT, supporting the benefits and safety of intensive BP control in adults with diabetes. This trial is registered at clinicaltrials.gov, number: NCT00145925.
OBJECTIVE: Observational data suggest a potential for subclinical cardiac damage from intensive blood glucose or blood pressure (BP) control, particularly in adults with very low blood glucose and BP levels. However, this has not been tested in a randomized trial. METHODS: The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Research Controlled Evaluation (ADVANCE) study was a factorial, randomized trial designed to test the effects of intensive blood glucose (hemoglobin A1c ≤6.5% versus usual care) and intensive BP (combination of perindopril-indapamide versus placebo) control on vascular events in adults with diabetes. Using mixed effects tobit models, we determined the effect of the randomized interventions on change in subclinical cardiac injury (high sensitivity cardiac troponin T [hs-cTnT]) and strain (N-terminal b-type pro natriuretic peptide [NT-proBNP]), 1 year after randomization. RESULTS: Among the 682 participants, mean age was 66.1 (SD, 6.5) years; 40% were women. Mean baseline hemoglobin A1c was 7.4% (SD, 1.5) and systolic/diastolic BP was 147 (SD,21)/81 (SD,11) mmHg. After 1 year, intensive versus standard glucose control did not significantly change hs-cTnT (1.5%; 95%CI:-4.9,8.2) or NT-proBNP (-10.3%; 95%CI: -20.2%,0.9%). Intensive versus standard BP control also did not affect hs-cTnT (-2.9%; 95%CI: -8.9,3.6), but did significantly lower NT-proBNP by 21.6% (95%CI:-30.2%,-11.9%). Changes in systolic BP at 1 year (versus baseline) were strongly associated with NT-proBNP (P = 0.004), but not hs-cTnT (P = 0.95). CONCLUSIONS: In adults with diabetes, intensive BP control reduced NT-proBNP without increasing hs-cTnT, supporting the benefits and safety of intensive BP control in adults with diabetes. This trial is registered at clinicaltrials.gov, number: NCT00145925.
Authors: Alexandra K Lee; John W McEvoy; Ron C Hoogeveen; Christie M Ballantyne; Elizabeth Selvin Journal: J Am Coll Cardiol Date: 2016-09-20 Impact factor: 24.094
Authors: Elizabeth Selvin; Mariana Lazo; Yuan Chen; Lu Shen; Jonathan Rubin; John W McEvoy; Ron C Hoogeveen; A Richey Sharrett; Christie M Ballantyne; Josef Coresh Journal: Circulation Date: 2014-08-22 Impact factor: 29.690
Authors: Elizabeth Selvin; Michael W Steffes; Hong Zhu; Kunihiro Matsushita; Lynne Wagenknecht; James Pankow; Josef Coresh; Frederick L Brancati Journal: N Engl J Med Date: 2010-03-04 Impact factor: 91.245
Authors: Lesley A Inker; Christopher H Schmid; Hocine Tighiouart; John H Eckfeldt; Harold I Feldman; Tom Greene; John W Kusek; Jane Manzi; Frederick Van Lente; Yaping Lucy Zhang; Josef Coresh; Andrew S Levey Journal: N Engl J Med Date: 2012-07-05 Impact factor: 91.245
Authors: Dario Giugliano; Maria Ida Maiorino; Giuseppe Bellastella; Paolo Chiodini; Katherine Esposito Journal: J Am Heart Assoc Date: 2019-06-05 Impact factor: 5.501
Authors: Elizabeth Selvin; Dan Wang; John William McEvoy; Stephen P Juraschek; Mariana Lazo; Pavel Hamet; Mark E Cooper; Michel Marre; Bryan Williams; Stephen Harrap; John Chalmers; Mark Woodward Journal: Diabetes Obes Metab Date: 2019-05-29 Impact factor: 6.577