Effect Of Basal Insulin Glargine On First And Recurrent Episodes Of Heart Failure Hospitalization The Origin Trial (Outcome Reduction With Initial Glargine Intervention)
CIRCULATION(2018)
摘要
Diabetes mellitus increases the incidence of recurrent heart failure through a variety of potential mechanisms, including ischemic myocardial damage, hyperglycemia, and the effects of the glucose-linked metabolic abnormalities on the myocardium.1 To date, randomized controlled trials of more versus less glucose lowering with a menu of drugs, including insulin, have reported a neutral effect on incident heart failure. Nevertheless, epidemiological studies and the sodium-retaining properties of insulin have fueled concerns about a possible link.2The ORIGIN trial (Outcome Reduction With Initial Glargine Intervention) allocated 12 537 people (mean age, 64 years; 35% women) with diabetes mellitus (88%), impaired glucose tolerance, or impaired fasting glucose to either basal insulin-mediated normoglycemia or therapy without insulin and reported a neutral effect on cardiovascular events during a median follow-up of 6.2 years. People with New York Heart Association class 3 or 4 heart failure were excluded. Heart failure requiring hospitalization was a prespecified component of the primary outcome and was defined as evidence of overnight hospitalization or attendance in an acute care setting for at least 2 of the following: signs or symptoms of heart failure; radiological evidence of congestive heart failure; treated with intravenous diuretics, or a first or increased dose of an oral diuretic, intravenous or oral vasodilator, or intravenous or oral inotrope.3 Both first and recurrent episodes were prospectively collected and …
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关键词
heart failure, hospitalization, insulin glargine
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