40181 - Are We Nearing the Limits of Office-Based CV...

Info iconThis preview shows pages 1–13. Sign up to view the full content.

View Full Document Right Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: Are We Nearing the Limits of Office-Based CV Prevention? Thomas G. Allison, PhD, MPH America the Beautiful? Continuum of CVD Prevention Public Health Community Programs Primary Prevention Clinic-based Acute Treatment Hospital-based Secondary Prevention Clinic-based Case Study • 62-year old white male • No known CV disease • Former smoker • BMI = 32.2 kg/m 2 • Taking ASA 81 mg/day Case Study • Type II diabetes x 10 years • Hemoglobin A1c = 6.5% • Diabetic medications – Metformin – Glimepiride – Rosiglitazone Case Study • Blood pressure = 134/64 mmHg – Blood pressure medications: • ACE-inhibitor • HCTZ • Lipids: – Total-C = 165 mg/dL HDL-C = 39 mg/dL – LDL-C = 95 mg/dL TG = 155 mg/dL • Rx = Simvastatin 40 mg/day Questions • Should we intensify diabetic therapy? – Add insulin? Add Exenatide? Other? • Should we attempt to lower systolic blood pressure? – Goal < 130 mg/Hg? < 120 mmHg? – Add beta blocker? Ca ++ blocker? ARB? • Are lipids satisfactory? – Higher dose or stronger statin? Add Ezetimibe? – Add fibrate? Add niacin? The ACCORD Trial The trial with 3 arms but no legs to stand on ACCORD Double 2 x 2 Factorial Design Intensive Glycemic Control 5128 Standard Glycemic Control 5123 Lipid BP Placebo Fibrate Intensive Standard 2371 2362 2753 2765 1383 1374 1391 1370 1193 1178 1184 1178 10,251 4733 * 5518 * 94% power for 20% reduction in event rate, assuming standard group rate of 4% / yr and 5.6 yrs follow-up ACCORD Baseline Patient Characteristics • Number of patients: 10,251 • Age: 62 years • Duration of diabetes: 10 years • Macrovascular disease: >35 % • HbA1c: 8.1% ACCORD-Glucose Treatment • Glycated hemoglobin: < 6.0% versus < 8.0% • Duration of follow-up: Median 3.4 yrs • Ending therapy: • Sulfonylurea: 78% vs. 68% • Repaglinide: 50% vs. 18% • Metformin: 74% vs. 67% • Rosiglitazone: 91% vs. 58% • Exenatide: 12% vs. 4% • Insulin: 77% vs. 35% ACCORD Glucose control...
View Full Document

This note was uploaded on 02/26/2012 for the course PHARM 210 taught by Professor Staff during the Fall '10 term at Rutgers.

Page1 / 35

40181 - Are We Nearing the Limits of Office-Based CV...

This preview shows document pages 1 - 13. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online