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

(Table 1) Reduced compounds of sulfur in waters of the Baltic Sea

Concentrations of sulfide, S°, and thiosulfate were determined in waters of the Baltic Sea. Microquantities of these compounds were observed in oxic waters. Concentration levels of reduced sulfur compounds in Baltic oxic waters were very close to levels of the Black Sea oxic zone. Thiosulfate and S° were predominate compounds in oxic water whereas sulfide was a predominant compound of Baltic waters high in hydrogen sulfide. Conclusion was made that during sedimentation in oxic waters anaerobic microorganisms along with aerobic bacteria take part in mineralization of organic matter. They exist on surfaces and in microniches of particles of organic detritus

Contencentrations of reduced inorganic sulfur forms in Mediterranean Sea waters

The first data on content of inorganic reduced sulfur compounds [H2S, S°, S2O3(2-), SO3(2-)] were obtained at two stations in the northeastern Levant Sea (Mediterranean Basin). With lower detection limit for the mentioned sulfur forms of 30 nM, sulfide forms were not found, while thiosulfate concentration varied from 178 to 890 nM (from 24 to 78 % of total reduced S), and S° varied from 156 to 1090 nM. Vertical distribution of these compounds showed irregular character; correlation between total reduced S maxima, fluorescence, and increase of nutrient element content near the lower pycnocline boundary was observed. The maximum total sulfur concentration in the surface layer was likely due an anthropogenic influence. The ''starting'' mechanism that controls appearance and distribution of sulfur compounds in oxygen-containing water is the process of bacterial sulfate reduction in micropatches of fresh organic detritus. Reduced sulfur forms participate further in a series of chemical and biochemical processes. Contribution of hydrolysis of organic sulfur-containing compounds is insignificant for the region in study

Sulfur speciation in bottom sediments from the Peru upwelling area

Sulfur speciation in bottom sediments from the area of the Peru upwelling has been studied. Data on sulfur contents in different compounds (sulfide, elemental, sulfate, pyritic and organic), water content, Eh, and organic carbon content in the bottom sediments have been obtained. The bottom sediments from the area are characterized by high content of organic carbon and low contents of total and reactive iron; this is typical for bottom sediments from ocean upwelling areas. Intense process of sulfate reduction occurs in the bottom sediments of the area, and accumulation of reduced sulfur compounds derivated from bacterial hydrogen sulfide does not exceed previously known values for other regions of the ocean

Some hydrophysical and hydrochemical parameters of the upper part of the hydrogen sulfide zone in the Black Sea, September 11-22, 1994

Features of spatial variability of hydrogen sulfide in the northeastern part of the Black Sea are estimated. Some technical aspects of H2S concentration determination in the anoxic zone are discussed: in its upper part at H2S concentration <30 µmol/l, the photometric method is recommended, while for deeper layers the iodometric method should be used. With linearity of vertical distribution of hydrogen sulfide and ammonium taken into account their vertical gradients are estimated as 0.49+/-0.04 µmol/m and 0.19+/-0.06 µmol/m respectively. It is shown that the upper boundary of the H2S layer corresponds to the isopycnal surface with Sigma_t = 16.19+/-0.05 arbitrary units. Special attention is paid to relationship of hydrogen sulfide distribution with hydrophysical features in the region under study, in particular in the coastal zone. It is shown that hydrodynamic conditions control spatial distribution of hydrogen sulfide. On the basis of isopycnal treatment of the H2S field existence of a coastal convergence zone is proved, and peculiarities are recognized of vertical circulation in the main Black Sea gyre and coastal anticyclonic eddies; here hydrogen sulfide serves as a tracer of hydrophysical mixing processes