Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor 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. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Proceedings of the Thirteenth International Society of Sports Nutrition (ISSN) Conference and Expo

Meeting Abstracts: Proceedings of the Thirteenth International Society of Sports Nutrition (ISSN) Conference and Expo Clearwater Beach, FL, USA. 9-11 June 201

Sweet waste extract uptake by a mosquito vector: Survival, biting,fecundity responses, and potential epidemiological significance

tIn nature, adult mosquitoes typically utilize nectar as their main energy source, but they can switch toother as yet unidentified sugary fluids. Contemporary lifestyles, with their associated unwillingness toconsume leftovers and improper disposal of waste, have resulted in the disposal of huge amounts of wasteinto the environment. Such refuse often contains unfinished food items, many of which contain sugarand some of which can collect water from rain and generate juices. Despite evidence that mosquitoescan feed on sugar-rich suspensions, semi-liquids, and decaying fruits, which can be abundant in garbagesites, the impacts of sweet waste fluids on dengue vectors are unknown. Here, we investigated the effectsof extracts from some familiar sweet home waste items on key components of vectorial capacity ofAedes aegypti. Adult mosquitoes were fed one of five diets in this study: water (WAT); sucrose (SUG);bakery product (remnant of chocolate cake, BAK); dairy product (yogurt, YOG); and fruit (banana (BAN).Differences in survival, response time to host, and egg production were examined between groups. Forboth males and females, maintenance on BAK extract resulted in marked survival levels that were similarto those seen with SUG. Sweet waste extracts provided better substrates for survival compared to water,but this superiority was mostly seen with BAK. Females maintained on BAK, YOG, and BAN exhibitedshorter response times to a host compared to their counterparts maintained on SUG. The levels of eggproduction were equivalent in waste extract- and SUG-fed females. The findings presented here illustratethe potential of sweet waste-derived fluids to contribute to the vectorial capacity of dengue vectors andsuggest the necessity of readdressing the issue of waste disposal, especially that of unfinished sweetfoods. Such approaches can be particularly relevant in dengue endemic areas where rainfall is frequentand waste collection infrequent

Courtship activity, copulation & insemination success in a mosquito vector fed a herbal aphrodisiac: Implications for sterile insect technology

Background & objectives: In sterile insect technology (SIT), mating competitiveness is a pre-condition for the reduction of target pest populations and a crucial parameter for judging efficacy. Still, current SIT trials are being hindered by decreased effectiveness due to reduced sexual performance of released males. Here, we explored the possible role of a herbal aphrodisiac in boosting the mating activity of Aedes aegypti. Methods: Males were fed one of two diets in this study: experimental extract of Eurycoma longifolia (MSAs) and sugar only (MSOs). Differences in life span, courtship latency, copulation activity and mating success were examined between the two groups. Results: No deaths occurred among MSA and MSO males. Life span of MSOs was similar to that of MSAs. The courtship latency of MSAs was shorter than that of MSOs (P<0.01). MSAs had greater copulation success than MSOs (P<0.001). In all female treatments, MSAs mated more than MSOs, but the differences in rate were significant only in the highest female density (P<0.05). In MSAs, mating success varied significantly with female density (P<0.01), with the 20-female group (P<0.01) having the lowest rate. Single MSA had better mating success at the two lowest female densities. In MSOs, there were no significant differences in mating success rate between the different female densities. Interpretation & conclusions: Our results suggested that the herbal aphrodisiac, E. longifolia, stimulated the sexual activity of Ae. aegypti and may be useful for improving the mating competitiveness of sterile males, thus improving SIT programmes

Volumen 18 Número 1

Revista seriada del Instituto Humboldt en asocio con el Invemar, el Instituto de Ciencias Naturales (ICN) y el Missouri Botanical Garden, como una estrategia para ampliar la base del conocimiento de uno de los países con mayor diversidad biológica del mundo. Inicia como una publicación de listados de especies pero en 2005 amplía su espectro temático hacia la sistemática y la biogeografía. En 2010, a propósito del Año Internacional de la Biodiversidad y en pro del conocimiento, la conservación y el uso sostenible de la biodiversidad, se abre a un público más amplio, considerando trabajos inéditos de investigación sobre botánica, zoología, ecología, biología, limnología, pesquerías, conservación, manejo de recursos y uso de la biodiversidad, con buena aceptación por parte de la comunidad científica y académica. En 2013, en asocio con el SiB Colombia y con el apoyo de la GBIF, se institucionaliza la inclusión de Artículos de Datos (Data Papers) en Biota Colombiana

Volumen 18 Número 1

Revista seriada del Instituto Humboldt en asocio con el Invemar, el Instituto de Ciencias Naturales (ICN) y el Missouri Botanical Garden, como una estrategia para ampliar la base del conocimiento de uno de los países con mayor diversidad biológica del mundo.Inicia como una publicación de listados de especies pero en 2005 amplía su espectro temático hacia la sistemática y la biogeografía. En 2010, a propósito del Año Internacional de la Biodiversidad y en pro del conocimiento, la conservación y el uso sostenible de la biodiversidad, se abre a un público más amplio, considerando trabajos inéditos de investigación sobre botánica, zoología, ecología, biología, limnología, pesquerías, conservación, manejo de recursos y uso de la biodiversidad, con buena aceptación por parte de la comunidad científica y académica. En 2013, en asocio con el SiB Colombia y con el apoyo de la GBIF, se institucionaliza la inclusión de Artículos de Datos (Data Papers) en Biota Colombiana.Artículo revisado por pare