Glycemic control for macrovascular disease in type II diabetes: Evidence and insights from recent trials  Sanjay Rajagopalan  Journal of Indian College of Cardiology  Volume 5, Pages S83-S94 (March 2015) DOI: 10.1016/j.jicc.2015.03.006 Copyright © 2015 Terms and Conditions

Fig. 1 Survival data from 820,900 individuals in 97 prospective studies. Source: Seshasai SR, et al. N Engl J Med. 2011; 364(9):829–841 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 2 Trends in age-standardized rates of diabetes-related complications in U.S adults. Source: Gregg EW et al. NEJM. April 17, 2014; 370; 1514–1523 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 3 Annual event rate due to coronary heart disease and MI observed in various diabetes trials. Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 4 Comparison of the BARI 2D and the SYNTAX trials, in terms of CV events. Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 5 Blood glucose levels and vascular risk in diabetes – Best Evidence. (Diabetes Related End-Points: Sudden death, death from hyperglycemia or hypoglycemia, fatal or non-fatal MI, angina, heart failure, stroke, renal failure, amputation [of at least one digit], vitreous hemorrhage, retinal photocoagulation, blindness in one eye, or cataract extraction). Source: UK Prospective Diabetes Study Group. Lancet. 1998; 352(9131):837–853 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 6 Blood glucose and vascular risk in diabetes best evidence: 2000. Source: Stratton IM, et al. BMJ. 2000; 321(7258):405–412 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 7 Benefit and risks of blood glucose control coexist: Evidence from UKPDS. The risks of diabetes complications significantly reduced for every 1% reduction of HbA1c. 1: Glycemia trials in perspective. 2: Glycemic targets set by various trials. Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 8 Impact of intensive therapy for diabetes: Legacy and vintage effects for CV events. Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 9 Hypoglycemia in the landmark trials. Source: Turnbull FM, et al. Diabetologia. 2009;52(11):2288–2298 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 10 Incident vascular outcomes and death among patients who had severe hypoglycemia in ADVANCE. Source: Zoungas N,et al. Engl J Med. 2010 Oct 7; 363(15):1410–8 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 11 10 year follow-up of UKPDS. Source: Holman R et al. N Engl J Med 2008; 359:1577–89 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 12 Effect of duration of diabetes (“vintage”) and other pre-specified sub-groups on major cardiovascular events. Source: Turnbull FM, et al. Diabetologia. 2009; 52(11):2288–2298 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 13 Heart disease prevention with improved glycemic control: Start early and continue long-term. Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 14 Steno-2: Effects of multifactorial intervention on CV outcomes. Source: Gaede P, et al. N Engl J Med. 2008; 358(6):580–591 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 15 Effect of early intensive therapy on outcomes detected by screening. Source: Griffin SJ, et al. Lancet. 2011;378(9786):156–167 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 16 Summary of pharmacological incretin action on different target tissues. Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 17 Macrovascular outcome trials. Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 18 SAVOR-TIMI primary outcome measure. Source: Scirica BM, et al.N Engl J Med. 2013 Oct 3;369(14):1317–6 and AHA Scientific Session, 2013 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions

Fig. 19 1: SAVOR-TIMI: Individual Endpoints of Secondary Composite End-Point: Expanded MACE. 2: SAVOR-TIMI: Risk of hospitalization for HF according to baseline NT-proBNP. Source: Scirica BM, et al.N Engl J Med. 2013 Oct 3;369(14):1317–6 and AHA Scientific Session, 2013 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: (10.1016/j.jicc.2015.03.006) Copyright © 2015 Terms and Conditions