General cardiology

Intensive glucose control reduces coronary events in type 2 diabetes

Although trials of intensive glucose control in type 2 diabetes have demonstrated clear reductions in microvascular outcomes, they have not shown consistent beneficial effects on cardiovascular events. Ray et al performed a meta-analysis of five randomised controlled trials of glucose control to determine if intensive glucose treatment influenced macrovascular events and all-cause mortality compared with standard treatment.

Data from 33 040 patients were analysed, and the five trials provided information on 1497 events of non-fatal myocardial infarction, 2318 coronary heart disease events, 1127 strokes and 2892 cases of all-cause mortality over approximately 163 000 person-years of follow-up. Those given intensive treatment had a mean HbA1c concentration that was 0.9% lower than for those given standard treatment. A 17% reduction in events of non-fatal myocardial infarction (OR = 0.83; 95% CI 0.75 to 0.93), and a 15% reduction in events of coronary heart disease (OR = 0.85; 95% CI 0.77 to 0.93) was seen in patients receiving intensive glycaemic control. However, no significant difference was seen in the number of stroke events, nor in all-cause mortality.

Conclusion

These results suggest that an intensive glucose control regimen can reduce coronary events in patients with type 2 diabetes, and support the current ACC and AHA recommendation that doctors should aim to lower HbA1c to a target of 7.0% or lower in these patients.

Ray KK, Seshasai SR, Wijesuriya S, . Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials. Lancet 2009;373:1765–72.

Cardiac resynchronisation may be a useful alternative to transplantation among appropriately selected patients

Cardiac transplantation (CTx) remains the preferred treatment for end-stage heart failure (ESHF); however, owing to worldwide donor shortage an alternative therapeutic strategy is often required. Among large randomised trials cardiac resynchronisation therapy (CRT) with biventricular pacing has been shown to reduce symptoms and improve left ventricular (LV) function among patients with advanced heart failure. However, it …