Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation: results of the ADVANCE study

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dc.contributor.author Du, X en
dc.contributor.author Ninomiya, T en
dc.contributor.author De Galan, B en
dc.contributor.author Abadir, E en
dc.contributor.author Chalmers, J en
dc.contributor.author Pillai, Avineshwaran en
dc.contributor.author Woodward, M en
dc.contributor.author Cooper, M en
dc.contributor.author Harrap, S en
dc.contributor.author Hamet, P en
dc.contributor.author Poulter, N en
dc.contributor.author Lip, G en
dc.contributor.author Patel, A en
dc.date.accessioned 2012-05-10T19:16:00Z en
dc.date.issued 2009 en
dc.identifier.citation European heart journal 30:1128-1139 Article number 9 2009 en
dc.identifier.issn 0195-668X en
dc.identifier.uri http://hdl.handle.net/2292/17848 en
dc.description.abstract Aims The aim of this study was to investigate serious clinical outcomes associated with atrial fibrillation (AF) and the effects of routine blood pressure lowering on such outcomes in the presence or absence of AF, among individuals with type 2 diabetes. Methods and results About 11 140 patients with type 2 diabetes (7.6% of whom had AF at baseline) were randomized to a fixed combination of perindopril and indapamide or placebo in the Action in Diabetes and Vascular Disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study. We compared total mortality and cardiovascular disease outcomes and effects of randomized treatment for 4.3 years on such outcomes between patients with and without AF at baseline. After multiple adjustments, AF was associated with a 61% (95% confidence interval 31–96, P < 0.0001) greater risk of all-cause mortality and comparable higher risks of cardiovascular death, stroke, and heart failure (all P < 0.001). Routine treatment with a fixed combination of perindopril and indapamide produced similar relative, but greater absolute, risk reductions for all-cause and cardiovascular mortalities in patients with AF, compared with those without AF. The number of patients needed to be treated with perindopril–indapamide for 5 years to prevent one cardiovascular death was 42 for patients with AF and 120 for patients without AF at baseline. Conclusion Atrial fibrillation is relatively common in type 2 diabetes and is associated with substantially increased risks of death and cardiovascular events in patients with type 2 diabetes. This arrhythmia identifies individuals who are likely to obtain greater absolute benefits from blood pressure-lowering treatment. Atrial fibrillation in diabetic patients should be regarded as a marker of particularly adverse outcome and prompt aggressive management of all risk factors. en
dc.publisher European Society of Cardiology en
dc.relation.ispartofseries European Heart Journal en
dc.relation.isreplacedby 2292/46915 en
dc.relation.isreplacedby http://hdl.handle.net/2292/46915 en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. Details obtained from http://www.sherpa.ac.uk/romeo/issn/0195-668X/ en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.title Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation: results of the ADVANCE study en
dc.type Journal Article en
dc.identifier.doi 10.1093/eurheartj/ehp055 en
pubs.begin-page 1128 en
pubs.volume 30 en
dc.rights.holder Copyright: European Society of Cardiology en
dc.identifier.pmid 19282274 en
pubs.end-page 1135 en
dc.rights.accessrights http://purl.org/eprint/accessRights/RestrictedAccess en
pubs.subtype Article en
pubs.elements-id 295836 en
pubs.org-id Science en
pubs.org-id Statistics en
dc.identifier.eissn 1522-9645 en
pubs.number 9 en
pubs.record-created-at-source-date 2012-02-16 en
pubs.dimensions-id 19282274 en

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