Reducing cardiovascular risk in diabetes: insights from the ADVANCE study

BACKGROUND Blood pressure is an important determinant of the risks of macrovascular and microvascular complications of type 2 diabetes. That’s why guidelines recommend intensive lowering of blood pressure in those patients. The ADVANCE (Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation) study has been recently introduced. It assessed the effects of such an approach on vascular disease using a fixed combination of the ACE-inhibitor perindopril, and the diuretic indapamide, in a population of patients with type 2 diabetes and a broad range of blood pressure values. METHODS After a 6-week active run-in period, 11,140 patients with type 2 diabetes were randomised to treatment with a fixed combination of perindopril and indapamide or matching placebo, in addition to current therapy. Primary end-points: major macrovascular and microvascular events, defined as death from cardiovascular disease, non-fatal stroke or non-fatal myocardial infarction, and new or worsening renal or diabetic eye disease. The macrovascular and microvascular composites were analysed jointly and separately. RESULTS To the end of the follow-up a meaningful reduction of the deaths has been obtained, both for cardiovascular causes and for macro and microvascular events, examined in together (in the total) (separately significance has not turned out). The best result has been obtained in the reduction of the renal events. DISCUSSION AND CONCLUSIONS The authors conclude that routine administration of a fixed combination of perindopril and indapamide to patients with type 2 diabetes and with a good controlled blood pressure, was well tolerated and reduced the risks of major vascular events, including death, but it remains the doubt if these results have been obtained because of the better pressure control or are specific of this preconstructed association.