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Professor Martin Cowie: Perhaps I can ask John McMurray to clarify the situation about diabetes in the EPHESUS study?

Professor John McMurray: As you know the highest risk patients after an infarct are women, the elderly, diabetics and those with either heart failure or left ventricular systolic dysfunction, and those groups overlap enormously. So, for example, if you are diabetic you are much more likely to develop heart failure even if you don’t have a low ejection fraction after infarction. The idea behind EPHESUS, as was the idea behind similar trials of ACE inhibitor and ARB after myocardial infarction, was to identify a high risk subset of patients in whom to test the treatment. EPHESUS simply identified patients as being at very high risk by having a low ejection fraction and evidence of heart failure or diabetes. So even though we are focusing on heart failure today, another route to get into EPHESUS was to have diabetes and a low ejection fraction, as opposed to signs of heart failure. I have not been able to tease out how many patients entered the trial on the basis of having diabetes and low ejection fraction, but without …

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