Reduced Cardiovascular Morbidity and Mortality in Hypertensive Diabetic Patients on First-Line Therapy With an ACE Inhibitor Compared With a Diuretic/ -Blocker-Based Treatment Regimen: A subanalysis of the Captopril Prevention Project

Lung cancer remains a challenge in daily practice. Chemotherapy is first considered for advanced lung adenocarcinoma bearing no active driver mutations. Maintaining drug efficacy and overcoming drug resistance are essential. This study aimed to explore the real-world use of anti-diabetic agent metformin in combination with pemetrexed-based platinum doublets in a first-line setting. We retrospectively collected data during 2004~2013 from TaiwaN′s National Health Insurance Research Database to access the survival benefit of metformin combined with pemetrexed-based platinum doublets as a first-line therapy for diabetic patients with advanced lung adenocarcinoma. Demographic data and information regarding platinum reagents, diabetes medications, and metformin doses were gathered, and overall survival status regarding metformin use was analyzed. Overall survival status based on the daily dose and the calculated cumulative defined daily dose (DDD) of metformin prescribed during the first 3 months after lung cancer was diagnosed was also assessed. A total of 495 patients were enrolled with a mean age of 67 years old, and the majority of the patients were male. After adjusting for age, sex, diabetes medication, and platinum reagents used, the adjusted hazard ratio (HR) for the metformin-user group was 0.61 (95% confidence interval (CI); 0.46~0.79; p < 0.001). The metformin-user group had a survival benefit (log-rank p < 0.001). We analyzed metformin dosing during the first 3 months after lung cancer diagnosis, and for a daily dose ≥ 1500 mg, the adjusted hazard ratio (aHR) was 0.42 (95% CI; 0.27~0.65; p < 0.001). Regarding the cumulative DDD of metformin, a DDD equal to or exceeding 21 resulted in aHR of 0.48 (95% CI; 0.34~0.69; p < 0.001). In this study, we found that the combination of metformin and pemetrexed-based platinum doublets provides a robust survival benefit as a first-line therapy for diabetic patients with advanced lung adenocarcinoma. It is worth conducting a large and randomized clinical trial to further investigate the antitumor effects of metformin on advanced lung adenocarcinoma when used as a first-ling therapy, including in non-diabetic patients.

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Cardiac Autonomic Neuropathy Predicts Cardiovascular Morbidity and Mortality in Type 1 Diabetic Patients With Diabetic Nephropathy

Diabetes Care ◽

10.2337/diacare.29.02.06.dc05-1242 ◽

2006 ◽

Vol 29 (2) ◽

pp. 334-339 ◽

Cited By ~ 104

Author(s):

A. S. Astrup ◽

L. Tarnow ◽

P. Rossing ◽

B. V. Hansen ◽

J. Hilsted ◽

...

Keyword(s):

Diabetic Nephropathy ◽

Autonomic Neuropathy ◽

Cardiovascular Morbidity ◽

Morbidity And Mortality ◽

Cardiac Autonomic Neuropathy ◽

Diabetic Patients ◽

Cardiovascular Morbidity And Mortality ◽

Type 1 Diabetic Patients

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The Need for a More Stringent LDL-C Goal in Patients with Diabetes

Journal of Pharmacy Technology ◽

10.1177/875512250502100603 ◽

2005 ◽

Vol 21 (6) ◽

pp. 325-329

Author(s):

Julie S Altman ◽

Jessica L Kerr ◽

Margaret R Thrower

Keyword(s):

Diabetes Mellitus ◽

Relevant Literature ◽

Cardiovascular Morbidity ◽

Morbidity And Mortality ◽

Lipid Lowering ◽

Diabetic Patients ◽

Lipid Lowering Therapy ◽

Lipid Management ◽

Cardiovascular Morbidity And Mortality ◽

Patients With Diabetes

Objective: To review relevant literature supporting the need for intensive lipid management in patients with diabetes mellitus. Data Sources: A literature search using MEDLINE (1975–March 2005) was conducted. The search terms coronary disease, diabetes mellitus, hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins), lipoproteins, and low-density lipoprotein cholesterol (LDL-C) were used to identify published trials comparing the effects of intensive LDL-C lowering and cardiovascular morbidity and mortality. Study Selection and Data Extraction: Primary literature was evaluated and included in this review if the study was a large randomized trial containing a significant number of diabetic patients receiving primary prevention. For trials including patients without diabetes, an available sub-analysis of the diabetic population in that trial must have been available. Data Synthesis: The incidence of diabetes mellitus is rising in dramatic proportions throughout the nation. In addition to the diagnosis of diabetes, many of these patients also have preexisting risk factors that increase their risk for cardiovascular morbidity and mortality. In 2004, the National Cholesterol Education Program issued a scientific statement proposing a newer and lower optimal LDL-C goal for high-risk populations. This article reviews pertinent findings from recent clinical trials and guidelines discussing the need to integrate more stringent LDL-C goals into clinical practice. Conclusions: Although data are limited, all patients with diabetes mellitus, regardless of cardiovascular status, may benefit from lipid-lowering therapy with an optimal LDL-C goal of < 70 mg/dL.

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