Long-term effects of intensive XXXX lowering on cardiovascular outcomes.

@entity1 @entity64 @entity6 @entity4053 @entity164 @entity413 @entity583 @entity204 @entity65
BACKGROUND: Intensive @entity413 lowering has previously been shown to increase mortality among @entity1 with advanced @entity164 2 @entity6 and a high risk of @entity65 . This report describes the 5-year outcomes of a mean of 3.7 years of intensive @entity413 lowering on mortality and key cardiovascular events. METHODS: We randomly assigned @entity1 with @entity164 2 @entity6 and @entity65 or additional cardiovascular risk factors to receive intensive therapy (targeting a glycated hemoglobin level below 6.0%) or standard therapy (targeting a level of 7 to 7.9%). After termination of the intensive therapy, due to higher mortality in the intensive-therapy group, the target glycated hemoglobin level was 7 to 7.9% for all @entity1 , who were followed until the planned end of the trial. RESULTS: Before the intensive therapy was terminated, the intensive-therapy group did not differ significantly from the standard-therapy group in the rate of the primary outcome (a composite of nonfatal @entity583 , @entity64 , or @entity204 from cardiovascular causes) (P=0.13) but had more deaths from any cause (primarily cardiovascular) (hazard ratio, 1.21; 95% confidence interval [CI], 1.02 to 1.44) and fewer nonfatal @entity583 (hazard ratio, 0.79; 95% CI, 0.66 to 0.95). These trends persisted during the entire follow-up period (hazard ratio for @entity204 , 1.19; 95% CI, 1.03 to 1.38; and hazard ratio for nonfatal @entity583 , 0.82; 95% CI, 0.70 to 0.96). After the intensive intervention was terminated, the median glycated hemoglobin level in the intensive-therapy group rose from 6.4% to 7.2%, and the use of @entity413 -lowering medications and rates of severe @entity4053 and other adverse events were similar in the two groups. CONCLUSIONS: As compared with standard therapy, the use of intensive therapy for 3.7 years to target a glycated hemoglobin level below 6% reduced 5-year nonfatal @entity583 but increased 5-year mortality. Such a strategy cannot be recommended for high-risk @entity1 with advanced @entity164 2 @entity6 . (Funded by the National Heart, Lung and Blood Institute; ClinicalTrials.gov number, NCT00000620.).
