Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation: Results of the ADVANCE study

Xin Du, Toshiharu Ninomiya, Bastiaan De Galan, Edward Abadir, John Chalmers, Avinesh Pillai, Mark Woodward, Mark Cooper, Stephen Harrap, Pavel Hamet, Neil Poulter, Gregory Y H Lip, Anushka Patel

Research output: Contribution to journalArticle

Abstract

AimsThe aim of this study was to investigate serious clinical outcomes associated with atrial fibrillation (AF) and the effects of routine blood pressure lowering on such outcomes in the presence or absence of AF, among individuals with type 2 diabetes.Methods and resultsAbout 11 140 patients with type 2 diabetes (7.6 of whom had AF at baseline) were randomized to a fixed combination of perindopril and indapamide or placebo in the Action in Diabetes and Vascular Disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study. We compared total mortality and cardiovascular disease outcomes and effects of randomized treatment for 4.3 years on such outcomes between patients with and without AF at baseline. After multiple adjustments, AF was associated with a 61 (95 confidence interval 31-96, P <0.0001) greater risk of all-cause mortality and comparable higher risks of cardiovascular death, stroke, and heart failure (all P <0.001). Routine treatment with a fixed combination of perindopril and indapamide produced similar relative, but greater absolute, risk reductions for all-cause and cardiovascular mortalities in patients with AF, compared with those without AF. The number of patients needed to be treated with perindopril-indapamide for 5 years to prevent one cardiovascular death was 42 for patients with AF and 120 for patients without AF at baseline.ConclusionAtrial fibrillation is relatively common in type 2 diabetes and is associated with substantially increased risks of death and cardiovascular events in patients with type 2 diabetes. This arrhythmia identifies individuals who are likely to obtain greater absolute benefits from blood pressure-lowering treatment. Atrial fibrillation in diabetic patients should be regarded as a marker of particularly adverse outcome and prompt aggressive management of all risk factors.

Original languageEnglish (US)
Pages (from-to)1128-1135
Number of pages8
JournalEuropean Heart Journal
Volume30
Issue number9
DOIs
StatePublished - May 2009
Externally publishedYes

Fingerprint

Atrial Fibrillation
Type 2 Diabetes Mellitus
Blood Pressure
Indapamide
Perindopril
perindopril drug combination indapamide
Mortality
Gliclazide
Numbers Needed To Treat
Vascular Diseases
Cardiac Arrhythmias
Cardiovascular Diseases
Therapeutics
Heart Failure
Myocardial Infarction
Placebos
Confidence Intervals

Keywords

  • Atrial fibrillation
  • Cardiovascular events
  • Diabetes mellitus
  • Mortality
  • Perindopril-indapamide
  • Randomized controlled trial

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation : Results of the ADVANCE study. / Du, Xin; Ninomiya, Toshiharu; De Galan, Bastiaan; Abadir, Edward; Chalmers, John; Pillai, Avinesh; Woodward, Mark; Cooper, Mark; Harrap, Stephen; Hamet, Pavel; Poulter, Neil; Lip, Gregory Y H; Patel, Anushka.

In: European Heart Journal, Vol. 30, No. 9, 05.2009, p. 1128-1135.

Research output: Contribution to journalArticle

Du, X, Ninomiya, T, De Galan, B, Abadir, E, Chalmers, J, Pillai, A, Woodward, M, Cooper, M, Harrap, S, Hamet, P, Poulter, N, Lip, GYH & Patel, A 2009, 'Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation: Results of the ADVANCE study', European Heart Journal, vol. 30, no. 9, pp. 1128-1135. https://doi.org/10.1093/eurheartj/ehp055
Du, Xin ; Ninomiya, Toshiharu ; De Galan, Bastiaan ; Abadir, Edward ; Chalmers, John ; Pillai, Avinesh ; Woodward, Mark ; Cooper, Mark ; Harrap, Stephen ; Hamet, Pavel ; Poulter, Neil ; Lip, Gregory Y H ; Patel, Anushka. / Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation : Results of the ADVANCE study. In: European Heart Journal. 2009 ; Vol. 30, No. 9. pp. 1128-1135.
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abstract = "AimsThe aim of this study was to investigate serious clinical outcomes associated with atrial fibrillation (AF) and the effects of routine blood pressure lowering on such outcomes in the presence or absence of AF, among individuals with type 2 diabetes.Methods and resultsAbout 11 140 patients with type 2 diabetes (7.6 of whom had AF at baseline) were randomized to a fixed combination of perindopril and indapamide or placebo in the Action in Diabetes and Vascular Disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study. We compared total mortality and cardiovascular disease outcomes and effects of randomized treatment for 4.3 years on such outcomes between patients with and without AF at baseline. After multiple adjustments, AF was associated with a 61 (95 confidence interval 31-96, P <0.0001) greater risk of all-cause mortality and comparable higher risks of cardiovascular death, stroke, and heart failure (all P <0.001). Routine treatment with a fixed combination of perindopril and indapamide produced similar relative, but greater absolute, risk reductions for all-cause and cardiovascular mortalities in patients with AF, compared with those without AF. The number of patients needed to be treated with perindopril-indapamide for 5 years to prevent one cardiovascular death was 42 for patients with AF and 120 for patients without AF at baseline.ConclusionAtrial fibrillation is relatively common in type 2 diabetes and is associated with substantially increased risks of death and cardiovascular events in patients with type 2 diabetes. This arrhythmia identifies individuals who are likely to obtain greater absolute benefits from blood pressure-lowering treatment. Atrial fibrillation in diabetic patients should be regarded as a marker of particularly adverse outcome and prompt aggressive management of all risk factors.",
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AU - De Galan, Bastiaan

AU - Abadir, Edward

AU - Chalmers, John

AU - Pillai, Avinesh

AU - Woodward, Mark

AU - Cooper, Mark

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KW - Cardiovascular events

KW - Diabetes mellitus

KW - Mortality

KW - Perindopril-indapamide

KW - Randomized controlled trial

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