Valsartan to prevent diabetes or heart attacks?

January 01, 0001

Valsartan to prevent diabetes or heart attacks?

In this double-blind, randomized clinical trial the US authors assigned 9306 patients with impaired glucose tolerance and established cardiovascular disease or cardiovascular risk factors to receive valsartan (up to 160 mg daily) or placebo (and nateglinide or placebo) in addition to lifestyle modification. They then followed the patients for a median of 5.0 years for the development of diabetes (6.5 years for vital status).They studied the effects of valsartan on the occurrence of three coprimary outcomes: the development of diabetes; an extended composite outcome of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, arterial revascularization, or hospitalization for unstable angina; and a core composite outcome that excluded unstable angina and revascularization.

They found: "The cumulative incidence of diabetes was 33.1% in the valsartan group, as compared with 36.8% in the placebo group (hazard ratio in the valsartan group 0.86). Valsartan, as compared with placebo, did not significantly reduce the incidence of either the extended cardiovascular outcome (14.5% vs. 14.8%) or the core cardiovascular outcome (8.1% vs. 8.1%)."

The authors concluded: "Among patients with impaired glucose tolerance and cardiovascular disease or risk factors, the use of valsartan for 5 years, along with lifestyle modification, led to a relative reduction of 14% in the incidence of diabetes but did not reduce the rate of cardiovascular events."

Surprise, surprise

For the full abstract, click here.

N Engl J Med 362(16):1477-1490, 22 April 2010
© 2010 to the Massachusetts Medical Society
Effect of Valsartan on the Incidence of Diabetes and Cardiovascular Events. The NAVIGATOR Study Group. Correspondence to Dr. Robert Califf: [email protected]

Category: T. Endocrine/Metabolic/Nutritional, K. Circulatory. Keywords: valsartan, glucose intolerance, diabetes type 2, death, cardiovascular, myocardial infarction, stroke, heart failure, revascularization, hospitalization, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 25 May 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.