Smokers lose at least one decade of life expectancy, as compared with those who have never smoked. Cessation before the age of 40 years reduces the risk of death associated with continued smoking by about 90%.

Summary Background There are few epidemiological studies of suicide in India. Methods A nationally representative mortality survey determined the cause of death occurring in 1·1 million homes in 6671 small areas chosen randomly from all parts of India. Two trained physicians independently assigned codes to the causes of death, based on a nonmedical surveyor’s field interview with household respondents. Findings About 3% of deaths at ages 15 years and older (2684/95 335) were due to suicide. This corresponds to about 187 000 suicide deaths in India in 2010 at these ages (115 000 men and 72 000 women; age-standardised rates per 100 000 at ages 15 years and older of 26·3 for men and 17·5 for women). For suicide deaths at ages 15 years and older 40% percent of male suicides and 56% of female suicides occurred at ages 15–29 years. A 15 year old in India had an approximate cumulative risk of 1·3% of dying before age 80 years by suicide; men had higher risk (1·7%) than women (1·0%), with especially high risks in South India (3·5% among men and 1·8% among women). Suicide risks were higher in educated versus illiterate adults. About half of the suicides were from poisoning, much of which was pesticide. At ages 15–29 years, suicide accounted for nearly as many deaths as transport accidents in men and maternal deaths in women. Interpretation Suicide death rates in India are amongst the highest in the world. A large proportion of suicides occur at younger ages, especially in women. Much of Indian suicides may be avoidable, starting with control of access to pesticides. Funding U.S. National Institutes of Health

BACKGROUNDFour glucagon-like peptide-1 (GLP-1) receptor agonists that are structurally similar to human GLP-1 have been shown to reduce the risk of adverse cardiovascular events among persons with type 2 diabetes. The effect of an exendin-based GLP-1 receptor agonist, efpeglenatide, on cardiovascular and renal outcomes in patients with type 2 diabetes who are also at high risk for adverse cardiovascular events is uncertain. METHODSIn this randomized, placebo-controlled trial conducted at 344 sites across 28 countries, we evaluated efpeglenatide in participants with type 2 diabetes and either a history of cardiovascular disease or current kidney disease (defined as an estimated glomerular filtration rate of 25.0 to 59.9 ml per minute per 1.73 m 2 of body-surface area) plus at least one other cardiovascular risk factor. Participants were randomly assigned in a 1:1:1 ratio to receive weekly subcutaneous injections of efpeglenatide at a dose of 4 or 6 mg or placebo. Randomization was stratified according to use of sodium-glucose cotransporter 2 inhibitors. The primary outcome was the first major adverse cardiovascular event (MACE; a composite of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular or undetermined causes). RESULTSA total of 4076 participants were enrolled; 2717 were assigned to receive efpeglenatide and 1359 to receive placebo. During a median follow-up of 1.81 years, an incident MACE occurred in 189 participants (7.0%) assigned to receive efpeglenatide (3.9 events per 100 person-years) and 125 participants (9.2%) assigned to receive placebo (5.3 events per 100 person-years) (hazard ratio, 0.73; 95% confidence interval [CI], 0.58 to 0.92; P<0.001 for noninferiority; P = 0.007 for superiority). A composite renal outcome event (a decrease in kidney function or macroalbuminuria) occurred in 353 participants (13.0%) assigned to receive efpeglenatide and in 250 participants (18.4%) assigned to receive placebo (hazard ratio, 0.68; 95% CI, 0.57 to 0.79; P<0.001). Diarrhea, constipation, nausea, vomiting, or bloating occurred more frequently with efpeglenatide than with placebo. CONCLUSIONSIn this trial involving participants with type 2 diabetes who had either a history of cardiovascular disease or current kidney disease plus at least one other cardiovascular risk factor, the risk of cardiovascular events was lower among those who received weekly subcutaneous injections of efpeglenatide at a dose of 4 or 6 mg than among those who received placebo. (Funded by Sanofi; AMPLITUDE-O ClinicalTrials.gov number, NCT03496298.