ACST-1: Difference between revisions

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==Clinical Question==
==Clinical Question==
<!-- This should be a PICO (Population, Intervention, Comparison, Outcome) style question. As an example, the ACCORD trial's clinical question is shown below, but you should replace it with the clinical question addressed by the trial you're summarizing. -->
<!-- This should be a PICO (Population, Intervention, Comparison, Outcome) style question. As an example, the ACCORD trial's clinical question is shown below, but you should replace it with the clinical question addressed by the trial you're summarizing. -->
In patients with type 2 diabetes mellitus, does intensive glycemic control targeting an HbA1c of <6% versus 7-7.9% reduce the risk of cardiovascular events?


==Bottom Line==
==Bottom Line==
<!-- What is the one thing you would want to take away from this article? Again, the ACCORD's bottom line is shown below, but you should replace it with yours. -->
<!-- What is the one thing you would want to take away from this article? Again, the ACCORD's bottom line is shown below, but you should replace it with yours. -->
Not only does targeting euglycemia (HbA1c <6%) not reduce cardiovascular risk, it is associated with increased mortality.


==Major Points==  
==Major Points==  
<!-- Now write a succinct paragraph or two describing the major points in the article. Again, ACCORD's major points: -->
<!-- Now write a succinct paragraph or two describing the major points in the article. Again, ACCORD's major points: -->
Several small and large randomized trials in diabetics had previously suggested a sizable benefit of tight glycemic control in reducing cardiovascular risk. The ACCORD trial was the largest study of its kind and demonstrated that not only does euglycemia (ie, HbA1c <6%) not reduce cardiovascular risk, it also is associated with a trend towards increased mortality.


==Guidelines==
==Guidelines==
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<!-- This section provides a bulleted-list summary of your trial's design. Use the ACCORD trial as a template. Don't worry about the asterisks; they're just bullets for a bulleted list. -->
<!-- This section provides a bulleted-list summary of your trial's design. Use the ACCORD trial as a template. Don't worry about the asterisks; they're just bullets for a bulleted list. -->


* Multicenter, double-blind, parallel-group, randomized, controlled trial
* Multicenter, randomized, controlled trial
* N=10,251
* N=3,120
** Intensive (n=5,128)
** Intensive (n=5,128)
** Standard (n=5,123)
** Standard (n=5,123)
* Setting: 77 centers in Canada and the United States
* Setting: 126 centres in 30 countries
* Enrollment: January to June 2001, February 2003 to October 2005
* Enrollment: January to June 2001, February 2003 to October 2005
* Mean follow-up: 3.5 years
* Mean follow-up: 3.5 years
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<!-- Jot down a quick bulleted list of inclusion criteria. Here are the ones from the ACCORD trial, but as before you should just replace them with the ones from the trial you're summarizing. -->
<!-- Jot down a quick bulleted list of inclusion criteria. Here are the ones from the ACCORD trial, but as before you should just replace them with the ones from the trial you're summarizing. -->


* Type 2 diabetes mellitus
* severe unilateral or bilateral carotid artery stenosis (no fixed cutoff but generally ≥60%)
* Hemoglobin A1c ≥7.5%
* this stenosis had not caused stroke, transient cerebral ischemia, or any other relevant neurological symptoms in the past 6 months
* Age 40-79 years with CAD or 55-79 years with
* fit for surgery, if required
* Anatomical evidence of significant atherosclerosis
* no circumstance or condition precluded long-term follow-up
* Albuminuria
* doctor and patient were both substantially uncertain whether to choose immediate CEA or deferral of any CEA.
* LVH
* ≥2 cardiovascular risk factors (dyslipidemia, HTN, current smoking, obesity)


===Exclusion Criteria===
===Exclusion Criteria===
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==Funding==
==Funding==
<!-- Who funded the study? Conflicts of interest? -->
UK Medical Research Council, BUPA Foundation, Stroke Association<!-- Who funded the study? Conflicts of interest? -->


==Further Reading==
==Further Reading==
<references/>
<references/>
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