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The trials differ in size and, to some degree, in their target population spanning from higher to lower CV risk, with some studying only people with established CV disease (i.e. the highest CV risk population) and others a mixed population consisting of those with CV risk factors and/or previous macrovascular complications.
This trial commenced in December 2009 and completed recruitment in March 2011 of 4339 patients (mean age 62.4 years, HbA1c 8.2%, BMI 32.1 kg/m, women/men 34%/66%) with T2DM and established CV disease (62.7%) or CV risk factors.
The authors concluded that maybe gliptins have a protective effect only in earlier stages of the natural history of T2DM (i.e., in younger subjects with a short duration of disease and without an established CV disease) whereas this benefit is lost in older patients with already established CV disease [ 85].
Most international treatment guidelines recommend lowering LDL-C to <2.6 mmol/l (100 mg/dl) in patients with high CV risk and to <1.8 to 2.0 mmol/l (70 to 80 mg/dl) in those at very high CV risk such as T2D with associated risk factors and established CV disease [ 3- 7].
In the current prospective analysis of plasma total adiponectin levels and CV mortality risk, where follow-up began at the time of blood collection, participants with established CV disease (defined as the occurrence of MI or coronary artery bypass grafting or stroke) before the diagnosis of diabetes were excluded from the present analyses [ 38, 39].
Based on these results, most international treatment guidelines recommend lowering LDL-C to <2.6 mmol/l (100 mg/dl) in patients with established CV disease and to <1.8 to 2.0 mmol/l (70 to 80 mg/dl) in those with very high CV risk, reducing total cholesterol to <4.5 mmol/l (174 mg/dl) with an option of <4 mmol/l (154 mg/dl) if feasible [ 6, 9, 24- 26].
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The EMPA-REG OUTCOME™ trial is an ongoing, randomized, placebo-controlled, clinical outcomes trial powered to establish the CV safety of empagliflozin with the potential to demonstrate cardioprotection in patients with T2DM at high risk of CV events who are receiving standard of care.
Comparisons between SCORE and REGICOR did not disclose that one of them might be better than the other in establishing the CV risk in Spanish individuals without rheumatic diseases [ 33- 37].
We acknowledge support by the National Institute of Health (DK60540, DK068152 to CV), the American Heart Association (Established Investigator Award to CV) and by the Endocrinology Training Grant to MAC.
Three experimental plantations were established in April 2003 (CV) and April 2008 (VT and SAV) from hardwood cuttings (25 cm long) planted at a distance of 2 × 0.75 m.
"He is a finisher with an already-established CV in the Bundesliga, where we have monitored him for the best part of two years.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com