***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT The worldwide explosive increase in type 2 diabetes mellitus and its cardiovascular morbidity are becoming major health concerns . OBJECTIVE To evaluate the effect of decreasing postpr and ial hyperglycemia with acarbose , an alpha-glucosidase inhibitor , on the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance ( IGT ) . DESIGN , SETTING , AND PARTICIPANTS International , multicenter double-blind , placebo-controlled , r and omized trial , undertaken in hospitals in Canada , Germany , Austria , Norway , Denmark , Sweden , Finl and , Israel , and Spain from July 1998 through August 2001 . A total of 1429 patients with IGT were r and omized with 61 patients ( 4 % ) excluded because they did not have IGT or had no postr and omization data , leaving 1368 patients for a modified intent-to-treat analysis . Both men ( 49 % ) and women ( 51 % ) participated with a mean ( SD ) age of 54.5 ( 7.9 ) years and body mass index of 30.9 ( 4.2 ) . These patients were followed up for a mean ( SD ) of 3.3 ( 1.2 ) years . INTERVENTION Patients with IGT were r and omized to receive either placebo ( n = 715 ) or 100 mg of acarbose 3 times a day ( n = 714 ) . MAIN OUTCOME MEASURES The development of major cardiovascular events ( coronary heart disease , cardiovascular death , congestive heart failure , cerebrovascular event , and peripheral vascular disease ) and hypertension ( > or = 140/90 mm Hg ) . RESULTS Three hundred forty-one patients ( 24 % ) discontinued their participation prematurely , 211 in the acarbose-treated group and 130 in the placebo group ; these patients were also followed up for outcome parameters . Decreasing postpr and ial hyperglycemia with acarbose was associated with a 49 % relative risk reduction in the development of cardiovascular events ( hazard ratio [ HR ] , 0.51 ; 95 % confidence interval [ CI ] ; 0.28 - 0.95 ; P = .03 ) and a 2.5 % absolute risk reduction . Among cardiovascular events , the major reduction was in the risk of myocardial infa rct ion ( HR , 0.09 ; 95 % CI , 0.01 - 0.72 ; P = .02 ) . Acarbose was also associated with a 34 % relative risk reduction in the incidence of new cases of hypertension ( HR , 0.66 ; 95 % CI , 0.49 - 0.89 ; P = .006 ) and a 5.3 % absolute risk reduction . Even after adjusting for major risk factors , the reduction in the risk of cardiovascular events ( HR , 0.47 ; 95 % CI , 0.24 - 0.90 ; P = .02 ) and hypertension ( HR , 0.62 ; 95 % CI , 0.45 - 0.86 ; P = .004 ) associated with acarbose treatment was still statistically significant . CONCLUSION This study suggests that treating IGT patients with acarbose is associated with a significant reduction in the risk of cardiovascular disease and hypertension OBJECTIVE —Hyperglycemia and Its Effect After Acute Myocardial Infa rct ion on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus ( HEART2D ) is a multinational , r and omized , controlled trial design ed to compare the effects of pr and ial versus fasting glycemic control on risk for cardiovascular outcomes in patients with type 2 diabetes after acute myocardial infa rct ion ( AMI ) . RESEARCH DESIGN AND METHODS — Patients ( type 2 diabetes , aged 30–75 years ) were r and omly assigned within 21 days after AMI to the 1 ) pr and ial strategy ( PR AND IAL ) ( three premeal doses of insulin lispro targeting 2-h postpr and ial blood glucose < 7.5 mmol/l ) or the 2 ) basal strategy ( BASAL ) ( NPH twice daily or insulin glargine once daily targeting fasting/premeal blood glucose < 6.7 mmol/l ) . RESULTS —A total of 1,115 patients were r and omly assigned ( PR AND IAL n = 557 ; BASAL n = 558 ) , and the mean patient participation after r and omization was 963 days ( range 1–1,687 days ) . The trial was stopped for lack of efficacy . Risks of first combined adjudicated primary cardiovascular events in the PR AND IAL ( n = 174 , 31.2 % ) and BASAL ( n = 181 , 32.4 % ) groups were similar ( hazard ratio 0.98 [ 95 % CI 0.8–1.21 ] ) . Mean A1C did not differ between the PR AND IAL and BASAL groups ( 7.7 ± 0.1 vs. 7.8 ± 0.1 % ; P = 0.4 ) during the study . The PR AND IAL group showed a lower daily mean postpr and ial blood glucose ( 7.8 vs. 8.6 mmol/l ; P < 0.01 ) and 2-h postpr and ial blood glucose excursion ( 0.1 vs. 1.3 mmol/l ; P < 0.001 ) versus the BASAL group . The BASAL group showed lower mean fasting blood glucose ( 7.0 vs. 8.1 mmol/l ; P < 0.001 ) and similar daily fasting/premeal blood glucose ( 7.7 vs. 7.3 mmol/l ; P = 0.233 ) versus the PR AND IAL group . CONCLUSIONS —Treating diabetic survivors of AMI with pr and ial versus basal strategies achieved differences in fasting blood glucose , less-than-expected differences in postpr and ial blood glucose , similar levels of A1C , and no difference in risk for future cardiovascular event rates BACKGROUND Improved blood-glucose control decreases the progression of diabetic microvascular disease , but the effect on macrovascular complications is unknown . There is concern that sulphonylureas may increase cardiovascular mortality in patients with type 2 diabetes and that high insulin concentrations may enhance atheroma formation . We compared the effects of intensive blood-glucose control with either sulphonylurea or insulin and conventional treatment on the risk of microvascular and macrovascular complications in patients with type 2 diabetes in a r and omised controlled trial . METHODS 3867 newly diagnosed patients with type 2 diabetes , median age 54 years ( IQR 48 - 60 years ) , who after 3 months ' diet treatment had a mean of two fasting plasma glucose ( FPG ) concentrations of 6.1 - 15.0 mmol/L were r and omly assigned intensive policy with a sulphonylurea ( chlorpropamide , glibenclamide , or glipizide ) or with insulin , or conventional policy with diet . The aim in the intensive group was FPG less than 6 mmol/L. In the conventional group , the aim was the best achievable FPG with diet alone ; drugs were added only if there were hyperglycaemic symptoms or FPG greater than 15 mmol/L. Three aggregate endpoints were used to assess differences between conventional and intensive treatment :  any diabetes-related endpoint ( sudden death , death from hyperglycaemia or hypoglycaemia , fatal or non-fatal myocardial infa rct ion , angina , heart failure , stroke , renal failure , amputation [ of at least one digit ] , vitreous haemorrhage , retinopathy requiring photocoagulation , blindness in one eye , or cataract extraction ) ; diabetes-related death ( death from myocardial infa rct ion , stroke , peripheral vascular disease , renal disease , hyperglycaemia or hypoglycaemia , and sudden death ) ; all-cause mortality . Single clinical endpoints and surrogate sub clinical endpoints were also assessed . All analyses were by intention to treat and frequency of hypoglycaemia was also analysed by actual therapy . FINDINGS Over 10 years , haemoglobin A1c ( HbA1c ) was 7.0 % ( 6.2 - 8.2 ) in the intensive group compared with 7.9 % ( 6.9 - 8.8 ) in the conventional group -- an 11 % reduction . There was no difference in HbA1c among agents in the intensive group . Compared with the conventional group , the risk in the intensive group was 12 % lower ( 95 % CI 1 - 21 , p=0.029 ) for any diabetes-related endpoint ; 10 % lower ( -11 to 27 , p=0.34 ) for any diabetes-related death ; and 6 % lower ( -10 to 20 , p=0.44 ) for all-cause mortality . Most of the risk reduction in the any diabetes-related aggregate endpoint was due to a 25 % risk reduction ( 7 - 40 , p=0.0099 ) in microvascular endpoints , including the need for retinal photocoagulation . There was no difference for any of the three aggregate endpoints between the three intensive agents ( chlorpropamide , glibenclamide , or insulin ) . Patients in the intensive group had more hypoglycaemic episodes than those in the conventional group on both types of analysis ( both p<0.0001 ) . The rates of major hypoglycaemic episodes per year were 0.7 % with conventional treatment , 1.0 % with chlorpropamide , 1.4 % with glibenclamide , and 1.8 % with insulin .  Weight gain was significantly higher in the intensive group ( mean 2.9 kg ) than in the conventional group ( p<0.001 ) , and patients assigned insulin had a greater gain in weight ( 4.0 kg ) than those assigned chlorpropamide ( 2.6 kg ) or glibenclamide ( 1.7 kg ) . INTERPRETATION Intensive blood-glucose control by either sulphonylureas or insulin substantially decreases the risk of microvascular complications , but not macrovascular disease , in patients with type 2 diabetes . ( ABSTRACT TRUNCATED CONTEXT The role of triglycerides in the risk of ischemic stroke remains controversial . Recently , a strong association was found between elevated levels of nonfasting triglycerides , which indicate the presence of remnant lipoproteins , and increased risk of ischemic heart disease . OBJECTIVE To test the hypothesis that increased levels of nonfasting triglycerides are associated with ischemic stroke  in the general population . DESIGN , SETTING , AND PARTICIPANTS The Copenhagen City Heart Study , a prospect i ve , Danish population -based cohort study initiated in 1976 , with follow-up through July 2007 . Participants were 13,956 men and women aged 20 through 93 years . A cross-sectional study included 9637 individuals attending the 1991 - 1994 examination of the prospect i ve study . MAIN OUTCOME MEASURES Prospect i ve study : baseline levels of nonfasting triglycerides , other risk factors at baseline and at follow-up examinations , and incidence of ischemic stroke . Cross-sectional study : levels of nonfasting triglycerides , levels of remnant cholesterol , and prevalence of ischemic stroke . RESULTS Of the 13,956 participants in the prospect i ve study , 1529 developed ischemic stroke . Cumulative incidence of ischemic stroke increased with increasing levels of nonfasting triglycerides ( log-rank trend , P < .001 ) . Men with elevated nonfasting triglyceride levels of 89 through 176 mg/dL had multivariate-adjusted hazard ratios ( HRs ) for ischemic stroke of 1.3 ( 95 % CI , 0.8 - 1.9 ; 351 events ) ; for 177 through 265 mg/dL , 1.6 ( 95 % CI , 1.0 - 2.5 ; 189 events ) ; for 266 through 353 mg/dL , 1.5 ( 95 % CI , 0.9 - 2.7 ; 73 events ) ; for 354 through 442 mg/dL , 2.2 ( 95 % CI , 1.1 - 4.2 ; 40 events ) ; and for 443 mg/dL or greater , 2.5 ( 95 % CI , 1.3 - 4.8 ; 41 events ) vs men with nonfasting levels less than 89 mg/dL ( HR , 1.0 ; 85 events ) ( P < .001 for trend ) . Corresponding values for women were 1.3 ( 95 % CI , 0.9 - 1.7 ; 407 events ) , 2.0 ( 95 % CI , 1.3 - 2.9 ; 135 events ) , 1.4 ( 95 % CI , 0.7 - 2.9 ; 26 events ) , 2.5 ( 95 % CI , 1.0 - 6.4 ; 13 events ) , and 3.8 
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They also showed that CVD events increased linearly , with no threshold , along with 2-h postmeal plasma glucose levels ( 7,8 ) .
In this issue of Diabetes Care , Cavalot et al. ( 10 ) add further evidence of the harmful relationship between postmeal glucose levels and