Post hoc subgroup analysis of the HEART2D trial demonstrates lower cardiovascular risk in older patients targeting postprandial versus fasting/premeal glycemia

Itamar Raz, Antonio Ceriello, Peter W. Wilson, Chakib Battioui, Eric W. Su, Lisa Kerr, Cate A. Jones, Zvonko Milicevic, Scott J. Jacober

Research output: Contribution to journalArticle

Abstract

OBJECTIVE - To identify the Hyperglycemia and Its Effect After Acute Myocardial Infarction on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus (HEART2D) trial subgroups with treatment difference. RESEARCH DESIGN AND METHODS - In 1,115 type 2 diabetic patients who had suffered from an acute myocardial infarction (AMI), the HEART2D trial compared two insulin strategies targeting postprandial or fasting/premeal glycemia on time until first cardiovascular event (cardiovascular death, nonfatal MI, nonfatal stroke, coronary revascularization, or hospitalization for acute coronary syndrome). The HEART2D trial ended prematurely for futility.We used the classification and regression tree (CART) to identify baseline subgroups with potential treatment differences. RESULTS - CART estimated the age of >65.7 years to best predict the difference in time to first event. In the subgroup aged >65.7 years (prandial, n = 189; basal, n = 210), prandial patients had a significantly longer time to first event and a lower proportion experienced a first event (n = 56 [29.6%] vs. n = 85 [40.5%]; hazard ratio 0.69 [95% CI 0.49-0.96]; P = 0.029), despite similar A1C levels. CONCLUSIONS - Older type 2 diabetic AMI survivors may have a lower risk for a subsequent cardiovascular event with insulin targeting postprandial versus fasting/premeal glycemia.

Original languageEnglish
Pages (from-to)1511-1513
Number of pages3
JournalDiabetes Care
Volume34
Issue number7
DOIs
Publication statusPublished - Jul 2011

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Fasting
Myocardial Infarction
Meals
Insulin
Medical Futility
Acute Coronary Syndrome
Hyperglycemia
Type 2 Diabetes Mellitus
Survivors
Hospitalization
Research Design
Stroke
Therapeutics

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing

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Post hoc subgroup analysis of the HEART2D trial demonstrates lower cardiovascular risk in older patients targeting postprandial versus fasting/premeal glycemia. / Raz, Itamar; Ceriello, Antonio; Wilson, Peter W.; Battioui, Chakib; Su, Eric W.; Kerr, Lisa; Jones, Cate A.; Milicevic, Zvonko; Jacober, Scott J.

In: Diabetes Care, Vol. 34, No. 7, 07.2011, p. 1511-1513.

Research output: Contribution to journalArticle

Raz, Itamar ; Ceriello, Antonio ; Wilson, Peter W. ; Battioui, Chakib ; Su, Eric W. ; Kerr, Lisa ; Jones, Cate A. ; Milicevic, Zvonko ; Jacober, Scott J. / Post hoc subgroup analysis of the HEART2D trial demonstrates lower cardiovascular risk in older patients targeting postprandial versus fasting/premeal glycemia. In: Diabetes Care. 2011 ; Vol. 34, No. 7. pp. 1511-1513.
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abstract = "OBJECTIVE - To identify the Hyperglycemia and Its Effect After Acute Myocardial Infarction on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus (HEART2D) trial subgroups with treatment difference. RESEARCH DESIGN AND METHODS - In 1,115 type 2 diabetic patients who had suffered from an acute myocardial infarction (AMI), the HEART2D trial compared two insulin strategies targeting postprandial or fasting/premeal glycemia on time until first cardiovascular event (cardiovascular death, nonfatal MI, nonfatal stroke, coronary revascularization, or hospitalization for acute coronary syndrome). The HEART2D trial ended prematurely for futility.We used the classification and regression tree (CART) to identify baseline subgroups with potential treatment differences. RESULTS - CART estimated the age of >65.7 years to best predict the difference in time to first event. In the subgroup aged >65.7 years (prandial, n = 189; basal, n = 210), prandial patients had a significantly longer time to first event and a lower proportion experienced a first event (n = 56 [29.6{\%}] vs. n = 85 [40.5{\%}]; hazard ratio 0.69 [95{\%} CI 0.49-0.96]; P = 0.029), despite similar A1C levels. CONCLUSIONS - Older type 2 diabetic AMI survivors may have a lower risk for a subsequent cardiovascular event with insulin targeting postprandial versus fasting/premeal glycemia.",
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AU - Battioui, Chakib

AU - Su, Eric W.

AU - Kerr, Lisa

AU - Jones, Cate A.

AU - Milicevic, Zvonko

AU - Jacober, Scott J.

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N2 - OBJECTIVE - To identify the Hyperglycemia and Its Effect After Acute Myocardial Infarction on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus (HEART2D) trial subgroups with treatment difference. RESEARCH DESIGN AND METHODS - In 1,115 type 2 diabetic patients who had suffered from an acute myocardial infarction (AMI), the HEART2D trial compared two insulin strategies targeting postprandial or fasting/premeal glycemia on time until first cardiovascular event (cardiovascular death, nonfatal MI, nonfatal stroke, coronary revascularization, or hospitalization for acute coronary syndrome). The HEART2D trial ended prematurely for futility.We used the classification and regression tree (CART) to identify baseline subgroups with potential treatment differences. RESULTS - CART estimated the age of >65.7 years to best predict the difference in time to first event. In the subgroup aged >65.7 years (prandial, n = 189; basal, n = 210), prandial patients had a significantly longer time to first event and a lower proportion experienced a first event (n = 56 [29.6%] vs. n = 85 [40.5%]; hazard ratio 0.69 [95% CI 0.49-0.96]; P = 0.029), despite similar A1C levels. CONCLUSIONS - Older type 2 diabetic AMI survivors may have a lower risk for a subsequent cardiovascular event with insulin targeting postprandial versus fasting/premeal glycemia.

AB - OBJECTIVE - To identify the Hyperglycemia and Its Effect After Acute Myocardial Infarction on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus (HEART2D) trial subgroups with treatment difference. RESEARCH DESIGN AND METHODS - In 1,115 type 2 diabetic patients who had suffered from an acute myocardial infarction (AMI), the HEART2D trial compared two insulin strategies targeting postprandial or fasting/premeal glycemia on time until first cardiovascular event (cardiovascular death, nonfatal MI, nonfatal stroke, coronary revascularization, or hospitalization for acute coronary syndrome). The HEART2D trial ended prematurely for futility.We used the classification and regression tree (CART) to identify baseline subgroups with potential treatment differences. RESULTS - CART estimated the age of >65.7 years to best predict the difference in time to first event. In the subgroup aged >65.7 years (prandial, n = 189; basal, n = 210), prandial patients had a significantly longer time to first event and a lower proportion experienced a first event (n = 56 [29.6%] vs. n = 85 [40.5%]; hazard ratio 0.69 [95% CI 0.49-0.96]; P = 0.029), despite similar A1C levels. CONCLUSIONS - Older type 2 diabetic AMI survivors may have a lower risk for a subsequent cardiovascular event with insulin targeting postprandial versus fasting/premeal glycemia.

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