***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: A survival analysis was applied to 1,453 patients treated between 1972 and 1978 in 33 French dialysis centers and prospect ively followed up in the computerized Diaphane Dialysis Registry . 198  deaths  ( overall mortality = OM ) were registered , of which 87 ( 43 % ) were secondary to cardiovascular complications ( cardiovascular mortality = CVM ) . Risk factors for OM and CVM ( p values less than 0.05 ) were age , male sex , nephroangiosclerosis or diabetic nephropathy as the primary renal disease , elevated systolic and diastolic blood pressure and two weekly dialysis rather then three . In contrast with the results observed for the general population , a high body mass index and elevated cholesterol , triglycerides and uric acid were not found to be associated with significantly increased CVM or OM . On the contrary , low body mass index ( less than 20 kg/m2 ) , low cholesterol ( less than 4.5 mmol/l ) and low mean predialysis blood urea ( less than 4.6 mmol/l ) were associated with increased OM and CVM , and more especially with high stroke mortality . Results for urea but not for cholesterol remain significant after adjustment for age , sex , weekly dialysis schedule and body mass index . They suggest that , in addition to elevated blood pressure , a poor nutritional state and /or low protein intake may be important factors for explaining the high cardiovascular mortality , particularly for strokes , observed in dialyzed patients Importance Current guidelines advocate the use of marine-derived omega-3 fatty acids supplements for the prevention of coronary heart disease and major vascular events  in people with prior coronary heart disease , but large trials of omega-3 fatty acids have produced conflicting results . Objective To conduct a meta- analysis of all large trials assessing the associations of omega-3 fatty acid supplements with the risk of  fatal and nonfatal coronary heart disease and major vascular events in the full study population and prespecified subgroups . Data Sources and Study Selection This meta- analysis included r and omized trials that involved at least 500 participants and a treatment duration of at least 1 year and that assessed associations of omega-3 fatty acids with the risk of vascular events . Data Extraction and Synthesis Aggregated study -level data were obtained from 10 large r and omized clinical trials . Rate ratios for each trial were synthesized using observed minus expected statistics and variances . Summary rate ratios were estimated by a fixed-effects meta- analysis using 95 % confidence intervals for major diseases and 99 % confidence intervals for all subgroups . Main Outcomes and Measures The main outcomes included fatal coronary heart disease , nonfatal myocardial infa rct ion , stroke , major vascular events , and all-cause mortality , as well as major vascular events in study population subgroups . Results Of the 77 917 high-risk individuals participating in the 10 trials , 47 803 ( 61.4 % ) were men , and the mean age at entry was 64.0 years ; the trials lasted a mean of 4.4 years . The associations of treatment with outcomes were assessed on 6273 coronary heart disease events ( 2695 coronary heart disease deaths and 2276 nonfatal myocardial infa rct ions ) and 12 001 major vascular events . R and omization to omega-3 fatty acid supplementation ( eicosapentaenoic acid dose range , 226 - 1800 mg/d ) had no significant associations with coronary heart disease death ( rate ratio [ RR ] , 0.93 ; 99 % CI , 0.83 - 1.03 ; P = .05 ) , nonfatal myocardial infa rct ion ( RR , 0.97 ; 99 % CI , 0.87 - 1.08 ; P = .43 ) or any coronary heart disease events ( RR , 0.96 ; 95 % CI , 0.90 - 1.01 ; P = .12 ) . Neither did r and omization to omega-3 fatty acid supplementation have any significant associations with major vascular events ( RR , 0.97 ; 95 % CI , 0.93 - 1.01 ; P = .10 ) , overall or in any subgroups , including subgroups composed of persons with prior coronary heart disease , diabetes , lipid levels greater than a given cutoff level , or statin use . Conclusions and Relevance This meta- analysis demonstrated that omega-3 fatty acids had no significant association with fatal or nonfatal coronary heart disease or any major vascular events . It provides no support for current recommendations for the use of such supplements in people with a history of coronary heart disease AIMS To compare the incidence of myocardial infa rct ion and death in non-diabetic subjects with and without insulin resistance . METHODS Population -based prospect i ve cohort study , in Malmö , Sweden , of 4748 non-diabetic subjects ( 60 % women ) , aged 46 - 68 years , with no history of myocardial infa rct ion or stroke . The prevalence of insulin resistance was established by the homeostasis model assessment ( HOMA ) and defined as values above the sex-specific 75th percentile ( 1.80 for women and 2.12 for men ) . Incidence of myocardial infa rct ion and death is based on record linkage with local and national registers . Cox 's proportional hazards model was used to assess the influence of insulin resistance after adjustment for age , sex , hyperglycaemia , raised arterial blood pressure , dyslipidaemia , central obesity , smoking and leisure-time physical activity . RESULTS Sixty-two subjects suffered a coronary event , and 93 subjects died during the 6-year follow-up period . Insulin resistance was after adjustment for other factors included in the insulin resistance syndrome and other potential confounders , associated with an increased incidence of coronary events ( relative risk ( RR ) 2.18 ; 95 % confidence interval ( CI ) 1.22 - 3.87 ; P = 0.008 ) and deaths ( RR 1.62 ; 1.03 - 2.55 ; P = 0.038 ) . CONCLUSIONS Insulin resistance , as assessed by the HOMA method , was in this cohort of middle-aged non-diabetic subjects associated with an increased incidence of myocardial infa rct ion and death . This risk remained when smoking , low physical activity and factors included in the insulin resistance syndrome were taken into account in a stepwise regression model BACKGROUND During the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) , patients with type 2 diabetes mellitus who received intensive glucose therapy  had a lower risk of microvascular complications than did those receiving conventional dietary therapy . We conducted post-trial monitoring to determine whether this improved glucose control persisted and whether such therapy had a long-term effect on macrovascular outcomes . METHODS Of 5102 patients with newly diagnosed type 2 diabetes , 4209 were r and omly assigned to receive either conventional therapy ( dietary restriction ) or intensive therapy ( either sulfonylurea or insulin or , in overweight patients , metformin ) for glucose control . In post-trial monitoring , 3277 patients were asked to attend annual UKPDS clinics for 5 years , but no attempts were made to maintain their previously assigned therapies . Annual question naires were used to follow patients who were unable to attend the clinics , and all patients in years 6 to 10 were assessed through question naires . We examined seven prespecified aggregate clinical outcomes from the UKPDS on an intention-to-treat basis , according to previous r and omization categories . RESULTS Between-group differences in glycated hemoglobin levels were lost after the first year . In the sulfonylurea-insulin group , relative reductions in risk persisted at 10 years for any diabetes-related end point ( 9 % , P=0.04 ) and microvascular disease ( 24 % , P=0.001 ) , and risk reductions for myocardial infa rct ion ( 15 % , P=0.01 ) and death from any cause ( 13 % , P=0.007 ) emerged over time , as more events occurred . In the metformin group , significant risk reductions persisted for any diabetes-related end point ( 21 % , P=0.01 ) , myocardial infa rct ion ( 33 % , P=0.005 ) , and death from any cause ( 27 % , P=0.002 ) . CONCLUSIONS Despite an early loss of glycemic differences , a continued reduction in microvascular risk and emergent risk reductions for myocardial infa rct ion and death from any cause were observed during 10 years of post-trial follow-up . A continued benefit after metformin therapy was evident among overweight patients . ( UKPDS 80 ; Current Controlled Trials number , IS RCT N75451837 . BACKGROUND The use of n-3 fatty acids may prevent cardiovascular events in patients with recent myocardial infa rct ion or heart failure . Their effects in patients with ( or at risk for ) type 2 diabetes mellitus are unknown . METHODS In this double-blind study with a 2-by-2 factorial design , we r and omly assigned 12,536 patients who were at high risk for cardiovascular events and had impaired fasting glucose , impaired glucose tolerance , or diabetes to receive a 1-g capsule containing at least 900 mg ( 90 % or more ) of ethyl esters of n-3 fatty acids or placebo daily and to receive either insulin glargine or st and ard care . The primary outcome was death from cardiovascular causes . The results of the comparison between n-3 fatty acids and placebo are reported here . RESULTS During a median follow up of 6.2 years , the incidence of the primary outcome was not significantly decreased among patients receiving n-3 fatty acids , as compared with those receiving placebo ( 574 patients [ 9.1 % ] vs. 581 patients [ 9.3 % ] ; hazard ratio , 0.98 ; 95 % confidence interval [ CI ] , 0.87 to 1.10 ; P=0.72 ) . The use of n-3 fatty acids also had no significant effect on the rates of major vascular events ( 1034 patients [ 16.5 % ] vs. 1017 patients [ 16.3 % ] ; hazard ratio , 1.01 ; 95 % CI , 0.93 to 1.10 ; P=0.81 ) , death from any cause ( 951 [ 15.1 % ] vs. 964 [ 15.4 % ] ; hazard ratio , 0.98 ; 95 % CI , 0.89 to 1.07 ; P=0.63 ) , or death from arrhythmia ( 288 [ 4.6 % ] vs. 259 [ 4.1 % ] ; hazard ratio , 1.10 ; 95 % CI , 0.93 to 1.30 ; P=0.26 ) . Triglyceride levels were reduced by 14.5 mg per deciliter ( 0.16 mmol per liter ) more among patients receiving n-3 fatty acids than among those receiving placebo ( P<0.001 ) , without a significant effect on other lipids . Adverse effects were similar in the two groups . CONCLUSIONS Daily supplementation with 1 g of n-3 fatty acids did not reduce the rate of cardiovascular events in patients at high risk for cardiovascular events . ( Funded by Sanofi ; ORIGIN Clinical Trials.gov number , NCT00069784 . ) Aims Low-density lipoprotein cholesterol predicts cardiovascular events in patients with diabetes . However , it is uncertain whether serum triglycerides level is also associated with an occurrence of future cardiovascular events in diabetic patients . We aim ed to test whether serum triglycerides is associated with first cardiovascular events in diabetic patients . Methods and results We recruited 5042 participants with diabetes mellitus from the st and ard versus intEnsive statin therapy for hypercholesteroleMic Patients with diAbetic retinopaTHY ( EMPATHY ) , multicenter , prospect i ve , r and omized , open-label , blinded-endpoint study . Median follow-up was three years . We evaluated an association of serum triglycerides with first cardiovascular events in cox-regression hazard models adjusted by age , sex , hypertension , current smoking , low-density lipoprotein cholesterol , and body mass index . Cardiovascular events were defined as ( a ) major adverse cardiac events including myocardial infa rct ion , stroke , or cardiac death ; and ( b ) cardiovascular diseases including myocardial infa rct ion , unstable angina , ischemic stroke , or large artery disease or peripheral arterial disease . Serum triglycerides were associated with major adverse cardiac events ( adjusted hazard ratio : 1.021 per 10 mg/dl ; 95 % confidence interval : 1.007–1.035 ; p = 0.0025 ) and cardiovascular diseases ( adjusted hazard ratio : 1.023 per 10 mg/dl ; 95 % confidence interval : 1.013–1. 
    Output:
    
Conclusions In T2DM patients , an elevated triglyceride level can not serve as an independent marker for an increased risk of cardiovascular events , but still , the higher serum TG levels tend to be associated with increased risks of CVD