Background: Glucagon-like peptide 1 agonists differ in chemical structure, duration of action and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. Methods: We randomly assigned patients with type 2 diabetes and cardiovascular disease to the addition of once-weekly subcutaneous injection of albiglutide (30 mg to 50 mg) or matching placebo to standard care. We hypothesized that albiglutide would be noninferior to placebo for the primary outcome of first occurrence of cardiovascular death, myocardial infarction, or stroke. If noninferiority was confirmed by an upper limit of the 95% confidence interval for the hazard ratio of less than 1.30, closed-testing for superiority was prespecified. Findings: Overall, 9463 participants were followed for a median of 1.6 years. The primary composite outcome occurred in 338 of 4731 patients (7.1%; 4.6 events per 100 person-years) in the albiglutide group and in 428 of 4732 patients (9.0%; 5.9 events per 100 person-years) in the placebo group (hazard ratio, 0.78; 95% confidence interval [CI ], 0.68 to 0.90), indicating that albiglutide, was superior to placebo (P<0.0001 for noninferiority, P=0.0006 for superiority). The incidence of acute pancreatitis (albiglutide 10 patients and placebo 7 patients), pancreatic cancer (6 and 5), medullary thyroid carcinoma (0 and 0), and other serious adverse events did not differ significantly between the two groups. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. (Funded by GlaxoSmithKline; Harmony Outcomes ClinicalTrials.gov number, NCT02465515.) noninferiority; P = 0.06 for superiority). There seems to be variation in the results of existing trials with GLP-1 receptor agonists, which if correct, might reflect drug structure or duration of action, patients studied, duration of follow-up or other factors.

AimThe objective was to examine the prevalence of atherosclerotic cardiovascular disease (ASCVD) and its risk factors among patients with RA with diabetes mellitus (RA-DM) and patients with RA without diabetes mellitus (RAwoDM), and to evaluate lipid and blood pressure (BP) goal attainment in RA-DM and RAwoDM in primary and secondary prevention.MethodsThe cohort was derived from the Survey of Cardiovascular Disease Risk Factors in Patients with Rheumatoid Arthritis from 53 centres/19 countries/3 continents during 2014–2019. We evaluated the prevalence of cardiovascular disease (CVD) among RA-DM and RAwoDM. The study population was divided into those with and without ASCVD, and within these groups we compared risk factors and CVD preventive treatment between RA-DM and RAwoDM.ResultsThe study population comprised of 10 543 patients with RA, of whom 1381 (13%) had DM. ASCVD was present in 26.7% in RA-DM compared with 11.6% RAwoDM (p<0.001). The proportion of patients with a diagnosis of hypertension, hyperlipidaemia and use of lipid-lowering or antihypertensive agents was higher among RA-DM than RAwoDM (p<0.001 for all). The majority of patients with ASCVD did not reach the lipid goal of low-density lipoprotein cholesterol <1.8 mmol/L. The lipid goal attainment was statistically and clinically significantly higher in RA-DM compared with RAwoDM both for patients with and without ASCVD. The systolic BP target of <140 mm Hg was reached by the majority of patients, and there were no statistically nor clinically significant differences in attainment of BP targets between RA-DM and RAwoDM.ConclusionCVD preventive medication use and prevalence of ASCVD were higher in RA-DM than in RAwoDM, and lipid goals were also more frequently obtained in RA-DM. Lessons may be learnt from CVD prevention programmes in DM to clinically benefit patients with RA .

Aims To assess differences in estimated cardiovascular disease (CVD) risk among rheumatoid arthritis (RA) patients from different world regions. Further to evaluate the management and goal attainment of lipids and blood pressure (BP). Methods and results The SUrvey of CVD Risk Factors in patients with RA was conducted in 14503 patients from 19 countries during 2014–2019. The treatment goal for BP was &lt;140/90 mmHg. CVD risk prediction and lipid goals were according to the 2016 European guidelines. Overall, 21% had a very high estimated risk of CVD, ranging from 5% in Mexico, 15% in Asia, 19% in Northern Europe, to 31% in Central and Eastern Europe and 30% in North America. Of the 52% with indication for lipid lowering treatment (LLT), 44% were using LLT. The lipid goal attainment was 45% and 18% in the high and very high-risk group, respectively. Use of statins in monotherapy was 24%, while 1% used statins in combination with other LLT. Sixty-two % had hypertension and approximately half of these patients were at BP goal. The majority of the patients used antihypertensive treatment in monotherapy (24%), while 10% and 5% as a two- or three drug combination. Conclusion We revealed considerable geographical differences in estimated CVD risk and preventive treatment. Low goal attainment for LLT was observed, and only half the patients obtained BP goal. Despite a high focus on the increased CVD risk in RA patients over the last decade, there is still substantial potential for improvement in CVD preventive measures.

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Background Brachial artery reactivity is one of the early surrogate markers of atherosclerosis. The association of impaired endothelium-dependent (EDVD) and endothelium-independent vasodilatation (EIVD) with structural measures of subclinical atherosclerosis in patients with rheumatoid arthritis (RA) is uncertain. Objectives To assess associations of EDVD and EIVD measures with carotid atherosclerosis in patients with RA free from overt cardiovascular disease. Methods This study included young and middle-aged patients (age 18-60 years) with RA who did not have symptoms of cardiovascular disease. All patients underwent carotid ultrasound examination. EDVD and nitroglycerin-induced EIVD of the brachial artery were assessed using high-resolution vascular ultrasound. Logistic regression models were used to study associations between carotid atherosclerosis and measures of vascular reactivity adjusting for age and sex. Results 124 patients with RA (35% with early RA) were enrolled in the study. Mean age was 45.7±9.26 years (14% males); 74% rheumatoid factor (RF) positive, DAS28 6,04±1,1, HAQ-DI 1,6±0,6. Atherosclerotic plaques were found in 38 (30,56%) of RA patients including 7 of 43 (16%) patients with early RA. EDVD in RA patients with atherosclerotic plaques (13.4±11.7%) was similar to that in patients without plaques (14±10.9%, p=0.79). However, RA patients with plaques showed significantly reduced EIVD (25.7±11.9%) than those without plaques (32.4±11.4%, p=0.01). Age (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.05-1.28) and reduced EIVD (OR 0.94, 95% CI 0.89-0.99) but not EDVD (OR 1.01, 95% CI 0.95-1.08) were associated with the presence of carotid atherosclerotic plaques. In fact, RA patients with EIVD less than twenty five percent and those older than fifty years were about 3-times more likely to have carotid atherosclerotic plaques than patients with EIVD over twenty five percent and those below fifty years of age (OR 3.0, 95% CI 1.03-8.8 and OR 2.7, 95% CI 1.01-7.44, respectively). The presence of both factors (EIVD of less than twenty five percent and age over fifty years) further increased the likelihood of having carotid plaques (OR 6.6, 95% CI 2.2-19.9). These associations remained significant after adjusting for RA disease activity, RA disease duration and cardiovascular risk factors. Conclusions Reduced EIVD and older age are associated with the presence of carotid plaques in RA patients independently of RA duration, disease activity and cardiovascular risk factors, and may be considered as indicators for evaluating atherosclerotic burden in patients with RA who do not have overt cardiovascular disease. Disclosure of Interest None Declared