Cardiovascular protection: a breakthrough for high-risk patients
Bibliographic record
Abstract
Blockade of the renin–angiotensin system (RAS) with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ARBs) has been shown to reduce cardiovascular mortality and morbidity in various patient populations. The recent ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomized AssessmeNt Study in aCE iNtolerant subjects with cardiovascular Disease (TRANSCEND) studies with the ARB telmisartan, the largest outcome trial programme with an ARB, have extended this evidence base in the broadest cross section of cardiovascular high-risk patients, and provided important new insights into the benefits of RAS blockade. ONTARGET and TRANSCEND recruited patients who were at high risk of vascular events. These patients, who did not have established heart failure and had well controlled blood pressure, had not previously been studied in clinical trials with ARBs. Telmisartan provided cardiovascular protection similar to ramipril but was better tolerated. These studies add to the growing evidence that the effects of RAS inhibitors are not solely dependent on blood pressure reduction. Angiotensin II exerts diverse pro-atherosclerotic effects, and hence blockade of the RAS may directly inhibit the development and progression of atherosclerosis. Finally, together with other smaller outcomes studies, ONTARGET and TRANSCEND provide useful insights into the relative importance of hypertension and other risk factors at different stages of the ‘cardiovascular continuum’. The evidence suggests that high blood pressure has a major impact on cardiovascular risk in the early stages of the continuum, whereas other risk factors like RAS activation become progressively important in later stages.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.011 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.004 | 0.006 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.005 | 0.016 |
| Insufficient payload (model declined to judge) | 0.015 | 0.007 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".