The period following heart failure hospitalization (HFH) is a vulnerable time with high rates of death or recurrent HFH.OBJECTIVE To evaluate clinical characteristics, outcomes, and treatment response to vericiguat according to prespecified index event subgroups and time from index HFH in the Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction (VICTORIA) trial. DESIGN, SETTING, AND PARTICIPANTSAnalysis of an international, randomized, placebo-controlled trial. All VICTORIA patients had recent (<6 months) worsening HF (ejection fraction <45%). Index event subgroups were less than 3 months after HFH (n = 3378), 3 to 6 months after HFH (n = 871), and those requiring outpatient intravenous diuretic therapy only for worsening HF (without HFH) in the previous 3 months (n = 801). Data were analyzed between May 2, 2020, and May 9, 2020.INTERVENTION Vericiguat titrated to 10 mg daily vs placebo. MAIN OUTCOMES AND MEASURESThe primary outcome was time to a composite of HFH or cardiovascular death; secondary outcomes were time to HFH, cardiovascular death, a composite of all-cause mortality or HFH, all-cause death, and total HFH. RESULTS Among 5050 patients in the VICTORIA trial, mean age was 67 years, 24% were women, 64% were White, 22% were Asian, and 5% were Black. Baseline characteristics were balanced between treatment arms within each subgroup. Over a median follow-up of 10.8 months, the primary event rates were 40.9, 29.6, and 23.4 events per 100 patient-years in the HFH at less than 3 months, HFH 3 to 6 months, and outpatient worsening subgroups, respectively. Compared with the outpatient worsening subgroup, the multivariable-adjusted relative risk of the primary outcome was higher in HFH less than 3 months (adjusted hazard ratio, 1.48; 95% CI, 1.27-1.73), with a time-dependent gradient of risk demonstrating that patients closest to their index HFH had the highest risk. Vericiguat was associated with reduced risk of the primary outcome overall and in all subgroups, without evidence of treatment heterogeneity. Similar results were evident for all-cause death and HFH. Addtionally, a continuous association between time from HFH and vericiguat treatment showed a trend toward greater benefit with longer duration since HFH. Safety events (symptomatic hypotension and syncope) were infrequent in all subgroups, with no difference between treatment arms.CONCLUSIONS AND RELEVANCE Among patients with worsening chronic HF, those in closest proximity to their index HFH had the highest risk of cardiovascular death or HFH, irrespective of age or clinical risk factors. The benefit of vericiguat did not differ significantly across the spectrum of risk in worsening HF.

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Background and aims: The purpose of this study was to evaluate the effects of sitagliptin 100 mg in the treatment of participants with type 2 diabetes mellitus who have inadequate glycemic control on metformin ≥1500mg/day. Materials and methods: Outpatients aged 52-72 years with type 2 diabetes. Patients were on metformin monotherapy (>=1500 mg/day) for >=8 weeks with a A1C >=7.5% and <=11.0% before treatment with sitagliptin. Glycemic efficacy endpoints were included the changes from baseline in A1C and FPG at week 26 and also Percentage of Participants Achieving a HbA 1c of <7%. Other efficacy endpoints that were assessed include changes from baseline at week 26 in body weight, and some safety endpoints such as hepatic safety tests ALT and AST, total and direct bilirubin, renal failure tests - serum creatinite calculated using the CKD-EPI formula, urinary albumin/creatinine ratio. The efficacy and safety were retrospectively evaluated by comparison of laboratory values before and after the administration of sitagliptin and by review of adverse events after treatment. Results: Target HbA 1c (<7%) was achieved in 83.3% overall with no incidence of hypoglycemic episodes ( and some other side-effects (25%-female genital mycotic infection). 26 weeks after the initiation of sitagliptin, participants’ hemoglobin A1c was significantly decreased by 13.99% ± 0.8% (mean HbA1c before administration was 8.76% ± 0.8%) . Furthermore, sitagliptin was well tolerated in the group. On logistic regression analysis, baseline HbA 1c was the strongest contributing factor for achieving target HbA 1c ; baseline body mass index and duration of diabetes were also significant factors. Conclusion. Sitagliptin as combination therapy with metformin was effective and safe in type 2 diabetes patients. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.