ADVANCE trial

Introduction

Action in Diabetes & Vascular Disease: preterAx & diamicroN-MR Controlled Evaluation (ADVANCE) study ,

Study characteristics:

• 11,140 adults with type 2 diabetes at high risk for cardiovascular disease
• ~7.6% had atrial fibrillation at baseline ,

Study design:

• randomized to either perindopril plus indapamide or placebo
• treatment to intensively lower blood glucose below 6.5% or standard treatment ,

Results:

• no difference in mortality with tight glycemic control; reasons for this are unclear
• at 4 years, patients with atrial fibrillation were at greater risk for all-cause mortality (hazard ratio, 1.6), heart failure (HR, 1.7), cerebrovascular events (HR, 1.7), & cardiovascular death (HR, 1.8), relative to those without atrial fibrillation
• blood pressure treatment reduced risk for cardiovascular mortality (RR=0.88) & all-cause mortality (RR=0.91) both among patients with & without atrial fibrillation
• patients with atrial fibrillation, compared with hypertensive patients without atrial fibrillation, saw greater absolute benefits from blood pressure therapy; the number needed to treat for 5 years to prevent one death was 42 among patients with atrial fibrillation & 120 among those without atrial fibrillation

More general terms

• clinical trial

Additional terms

• Action to Control Cardiovascular Risk in Diabetes (ACCORD trial)
• diabetes mellitus type 2 (insulin-resistant)