Among patients undergoing PCI for myocardial infarction, the rate of the composite of death from any cause, myocardial infarction, or major bleeding was not lower among those who received bivalirudin than among those who received heparin monotherapy. (Funded by the Swedish Heart-Lung Foundation and others; VALIDATE-SWEDEHEART ClinicalTrialsRegister.eu number, 2012-005260-10 ; ClinicalTrials.gov number, NCT02311231 .).

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OBJECTIVEThere has been conflicting evidence regarding the potential role of vitamin D in glucose homeostasis. This study was designed to investigate the effect of highdose vitamin D3 treatment on b-cell function, insulin sensitivity, and glucose tolerance in subjects with prediabetes or diet-treated type 2 diabetes. RESEARCH DESIGN AND METHODSSubjects (n = 44) were randomized to 30,000 IU vitamin D3 once weekly or placebo for 8 weeks. Hyperglycemic clamp assessed first-phase (0-12 min) and secondphase (12-120 min) insulin response, insulin sensitivity, and disposition index (DI). An oral glucose tolerance test assessed glucose tolerance and glycosylated hemoglobin assessed glycemic control. CONCLUSIONSThis study gives no support for any substantial effect of high-dose vitamin D treatment for 8 weeks in prediabetes or diet-treated type 2 diabetes on b-cell function, insulin sensitivity, or glycemic control.Evidence suggesting that vitamin D has an important role in glucose homeostasis has accumulated during the last three decades. A meta-analysis concluded that observational studies have demonstrated a relatively consistent association between low vitamin D serum levels and prevalence of type 2 diabetes or metabolic syndrome (1). Moreover, cohort studies have shown an inverse association between baseline

In aspirin-treated patients with CAD, prasugrel 5 mg in LBW patients reduced platelet reactivity to a similar extent as prasugrel 10 mg in HBW patients and resulted in greater platelet inhibition, lower HPR, and similar bleeding rates compared with clopidogrel. (Comparison of Prasugrel and Clopidogrel in Low Body Weight Versus Higher Body Weight With Coronary Artery Disease [FEATHER]; NCT01107925).

OBJECTIVE -The effect of exercise training and acarbose on glycemic control, insulin sensitivity, and phenotype was investigated in mild type 2 diabetes.RESEARCH DESIGN AND METHODS -Sixty-two men and women with type 2 diabetes were randomized to 12 weeks of structured exercise training with or without acarbose treatment or to acarbose alone. Glycemic control was determined by HbA 1c (A1C), insulin sensitivity (M value) by euglycemic-hyperinsulinemic clamp, and regional fat distribution by computerized tomography and dual X-ray absorptiometry. Physical fitness was determined as maximal oxygen uptake (VO 2max ). All investigations were performed before and after the intervention.RESULTS -Forty-eight subjects completed the study. Exercise improved M value by 92% (P ϭ 0.017) and decreased total and truncal fat (P ϭ 0.002, 0.001) and systolic blood pressure (P ϭ 0.01) but had no significant effect on VO 2max or A1C level. The combination of exercise and acarbose significantly decreased fasting plasma glucose, A1C, lipids, and diastolic blood pressure and increased VO 2max , whereas effects on M value and body composition were comparable with that of exercise alone. Acarbose alone had no significant effect on either M value or A1C but decreased systolic (P ϭ 0.001) and diastolic blood pressure (P ϭ 0.001) and fasting proinsulin level (P ϭ 0.009). Multiple regression analysis showed that addition of acarbose to exercise improved glycemic control.CONCLUSIONS -In subjects with mild type 2 diabetes, exercise training improved insulin sensitivity but had no effect on glycemic control. The addition of acarbose to exercise, however, was associated with significant improvement of glycemic control and possibly cardiovascular risk factors. Diabetes Care 29:1471-1477, 2006I t is well established that not only manifest type 2 diabetes but also impaired glucose tolerance and impaired fasting glucose constitute a significant risk for development of cardiovascular disease (CVD) (1). This risk can partly be explained by a concomitant high prevalence of traditional CVD risk factors, such as obesity, hypertension, insulin resistance, and dyslipidemia. However, the role of hyperglycemia per se, particularly postprandial hyperglycemia, in exacerbation of CVD has been demonstrated in both epidemiological and clinical studies (2,3). Accordingly, in the therapy of type 2 diabetes, advocated regimes focus on correcting traditional CVD risk factors and normalizing glycemia. Regular exercise training is perceived as a cornerstone of diabetes therapy, although the effect on HbA 1c (A1C) level is poorly documented in patients with mild hyperglycemia (4,5). Therefore, the main objective in the present study was to investigate, in patients with type 2 diabetes and mild hyperglycemia, the impact of structured moderate-to high-intensity exercise training alone or in combination with acarbose treatment on glycemic control, phenotype characteristics, and cardiovascular risk factor profile. In addition, we randomized patients to acarbose alone. Acarbos...