Liraglutide Reduces Cardiovascular Events and Mortality in Type 2 Diabetes Mellitus Independently of Baseline Low-Density Lipoprotein Cholesterol Levels and Statin Use
Notice bibliographique
Résumé
liraglutide T he causal relationship between low-density lipoprotein cholesterol (LDL-C) and atherosclerotic cardiovascular events has been well established.1 In people with type 2 diabetes mellitus, LDL-C lowering with statins is strongly endorsed by clinical practice guidelines, with suggested LDL-C target levels including <100 mg/dL for high-risk patients, <70 mg/dL for very high-risk patients, 2-4 and ≤55 mg/dL in patients with cardiovascular disease at extreme risk. 2 Because LDL-C is a dominant pathophysiological mechanism of atherogenesis, questions pertain to whether newer antiatherosclerotic and cardiovascular protective therapies exhibit efficacy, even in the setting of low LDL-C.In this post hoc analysis of the LEADER trial, we evaluated the efficacy of liraglutide on cardiovascular outcomes and mortality across the spectrum of baseline LDL-C and statin use. 5 LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results; https://www.clinicaltrials.gov;unique identifier: NCT01179048) was a randomized trial of liraglutide (1.8 mg or maximum tolerated dose) versus placebo in 9340 patients with type 2 diabetes mellitus and high cardiovascular risk (median follow-up, 3.8 years).5 The primary outcome was a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke (major adverse cardiovascular events [MACEs]).The key secondary outcome (expanded MACEs) also included coronary revascularization, hospitalization for unstable angina, and hospitalization for heart failure.The ethics committee or institutional review board at each center approved the trial protocol.Patients provided informed consent.Cardiovascular outcomes were prospectively adjudicated by an independent, blinded event adjudication committee.Tests for trends in risk of first MACE and cardiovascular death across the 3 baseline LDL-C groups were performed with the Cochran-Armitage test for trend applied in a logistic regression adjusted for prior cardiovascular disease.The treatment effect of liraglutide versus placebo on cardiovascular outcomes by LDL-C level <50, 50 to 70, and >70 mg/dL and statin use at baseline was estimated with Cox regression with treatment, groups by LDL-C level, and the interactions of both as factors and further adjusted for baseline cardiovascular risk factors (sex, region, smoking history, prior cardiovascular disease, antidiabetes medications, age, diabetes duration, and estimated glomerular filtration rate).5 In LEADER, 9187 patients had baseline LDL-C measured: 926 (10.1%), 2021 (22.0%), and 6240 (67.9%) had LDL-C <50, 50 to 70, or >70 mg/dL, respectively.Baseline demographics and risk factors were well balanced across LDL-C levels, except that the highest LDL-C group had a higher proportion of women, a lower incidence of prior myocardial infarction or stroke, and a lower rate of statin use compared with the other 2 groups.Mean LDL-C in the 3 groups was 38.7 (SD, 7.7), 61.9 (SD, 3.9), and 108.3 (SD, 30.9) mg/dL, respectively.At baseline, 72% were on a statin, with an additional 10% having statin added during the course of the study (9% in the liraglutide and 11% in the placebo group).
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,004 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».