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TECOS: underachievement on targets in secondary prevention diabetes patients

Action is needed to improve the care of type 2 diabetes patients with cardiovascular disease (CVD) to reduce their high risk of recurrent events.
TECOS (Trial Evaluating Cardiovascular Outcomes with Sitagliptin) was a multi-national, double-blind randomised placebo-controlled study of sitagliptin versus placebo in adults with type 2 diabetes and CVD (N=13,616). The primary report of this study conducted to meet the requirements of the FDA showed that the addition of sitagliptin to evidence-based usual care did not increase the risk of major adverse cardiovascular events, hospitalisation for heart failure or other adverse events over a mean follow-up of 3 years. This subsequent retrospective analysis evaluated attainment of five secondary prevention parameters—aspirin use, lipid control (low-density lipoprotein cholesterol [LDL-C] <70 mg/dL or statin therapy), blood pressure control (<140 mmHg systolic, <90 mmHg diastolic), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, and non-smoking status in the intention-to-treat TECOS cohort.
The results show the need for much work on goal attainment in high risk patients: less than one-third (29.9%) attained all five secondary prevention parameters. These patients had a 40% lower risk of a recurrent event compared with patients with control of ?2 parameters (adjusted hazard ratio 0.60, 95% CI 0.47-0.77). The biggest challenge was blood pressure control (only 57.9% attained guideline recommended goals).
This report underlines the need for improvement management of secondary prevention patients to optimise reduction in their risk of a recurrent event; however, even with this, a substantial residual cardiovascular risk persists.
Secondary prevention of cardiovascular disease in patients with type 2 diabetes: international insights from the TECOS Trial.

Pagidipati NJ, Navar AM, Pieper KS et al.