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The secondary CV endpoint included all relevant CV adverse events.
The Veterans Affairs Diabetes Trial (VADT) assessed the effect of intensive glycaemic control on a composite CV endpoint that included: MI, CV death, stroke, congestive heart failure, invasive revascularization, inoperable coronary artery disease and amputation for ischaemia 12.
Table 4 summarizes the incidence of each CV endpoint.
All RCTs were identified from Savarese et al. [ 82], except those studies with a CV endpoint.
Similar point estimates were observed for the broader secondary CV endpoint; however, the upper limit of the 95% CI was <1.3 for all methods.
The incidence rates (per 1000 patient-years) for the primary CV endpoint were 5.3 for linagliptin versus 16.8 for total comparators.
Similar(53)
Applying the FDA guidance on how to assess CV safety in the development of treatments for type 2 diabetes to this analysis, the HR point estimates were both <1 for the Primary MACE and Secondary CV endpoints resulting from the lower observed incidence of CV events with exenatide BID compared to the control group [ 37].
A large dedicated CV outcome study is underway to determine the effect of empagliflozin on CV endpoints (NCT01131676).
Based on the trial information outlined above, it seems reasonable to separate the test of glycemic control endpoints from CV endpoints to allow for evaluation of the glycemic-related endpoints without multiple comparison adjustments with respect to the CV endpoints.
These were related to bone fractures, heart failure and gastrointestinal bleeding, whereas the intended primary reduction of CV endpoints could not be substantiated.
cIMT values measured by ultrasound correlate closely with direct measurement of the local and systemic atherosclerotic burden in pathology studies and with clinical CV endpoints [ 4, 6].
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