Accelerated up-titration of RAS antagonists and beta-blockers to maximum tolerated dosages is an effective and safe intervention for the primary prevention of cardiac events for diabetic patients pre-selected using NT-proBNP. (Nt-proBNP Guided Primary Prevention of CV Events in Diabetic Patients [PONTIAC]; NCT00562952).

OBJECTIVE -Impaired endothelial function of resistance and conduit arteries can be detected in patients with type 1 diabetes. We studied whether a persistent improvement of endothelial function can be achieved by regular physical training.RESEARCH DESIGN AND METHODS -The study included 26 patients with type 1 diabetes of 20 Ϯ 10 years' duration and no overt angiopathy; 18 patients (42 Ϯ 10 years old) participated in a bicycle exercise training program, and 8 patients with type 1 diabetes (33 Ϯ 11 years old) served as control subjects. Vascular function of conduit arteries was assessed by flow-mediated and endothelium-independent dilation of the brachial artery and of resistance vessels by the response of ocular fundus pulsation amplitudes to intravenous N G -monomethyl-L-arginine (L-NMMA) at baseline, after 2 and 4 months of training, and 8 months after cessation of regular exercise.RESULTS -Training increased peak oxygen uptake (VO 2max ) by 13% after 2 months and by 27% after 4 months (P ϭ 0.04). Flow-mediated dilation (FMD) of the brachial artery increased from 6.5 Ϯ 1.1 to 9.8 Ϯ 1.1% (P ϭ 0.04) by training. L-NMMA administration decreased fundus pulsation amplitude (FPA) by 9.1 Ϯ 0.9% before training and by 13.4 Ϯ 1.5% after 4 months of training (P ϭ 0.02). VO 2max , FMD, and FPA were unchanged in the control group. Vascular effects from training were abrogated 8 months after cessation of exercise.CONCLUSIONS -Our study demonstrates that aerobic exercise training can improve endothelial function in different vascular beds in patients with long-standing type 1 diabetes, who are at considerable risk for diabetic angiopathy. However, the beneficial effect on vascular function is not maintained in the absence of exercise.

The correction of refractive error with LASIK in postkeratoplasty patients proved to be safe, effective, and predictable. Further studies with longer follow-up are needed to determine the method's clinical value.