Achieving lipid targets in adults with type 2 diabetes: the Stop Atherosclerosis in Native Diabetics Study.

BACKGROUND: Although lipid management in diabetes is standard practice, goals often are neither met nor maintained. Strategies for achieving lower targets have not been explored. The Stop Atherosclerosis in Native Diabetics Study randomized patients with diabetes to standard versus aggressive lipid and blood pressure goals for 36 months. OBJECTIVE: To report strategies used to achieve and maintain lipid goals and to report adverse events (AEs). METHODS: Adults with type 2 diabetes and no history of cardiovascular disease (N = 499) were randomized to standard (low-density lipoprotein cholesterol [LDL-C] ≤ 100 mg/dL, non-high-density lipoprotein cholesterol [non-HDL-C] ≤ 130 mg/dL) or aggressive (LDL-C ≤ 70 mg/dL, non-HDL-C ≤ 100 mg/dL) targets. An algorithm was started with statin monotherapy, with intestinally acting agents added as required to reach LDL-C targets.Triglyceride [TG]-lowering agents were next used to reach non-HDL-C goals. Lipid management was performed by mid-level practitioners, with physician consultation, by the use of point-of-care lipid determinations. RESULTS: On average, both groups achieved the LDL-C and non-HDL-C goals within 12 months and maintained them throughout the study. At 36 months, mean (SD) LDL-C and non-HDL-C were 72 (24) and 102 (29) mg/dL in the aggressive group (AGG) and 104 (20) and 138 (26) mg/dL, respectively, in the standard group (STD); systolic blood pressure targets were 115 and 130 mmHg, respectively. A total of 68% of participants reached target LDL-C for greater than 50% of the visits and 46% for greater than 75% of visits. At 36 months, the AGG averaged 1.5 lipid lowering medications and the STD 1.2. Statins were used in 91% and 68% of the AGG and STD; ezetimibe by 31% and 10%; fibrates by 8% and 18%. No serious AEs were observed; AEs occurred in 18% of the AGG and 14% of the STD. CONCLUSION: Standard and aggressive lipid targets can be safely maintained in diabetic patients. Standardized algorithms, point-of-care lipid testing, and nonphysician providers facilitate care delivery.

Dissociative melting of ice VII at high pressure.

We have used x-ray diffraction to determine the structure factor of water along its melting line to a static pressure of 57 GPa (570 kbar) and a temperature of more than 1500 K, conditions which correspond to the lower mantle of the Earth, and the interiors of Neptune and Uranus up to a depth of 7000 km. We have also performed corresponding first principles and classical molecular dynamics simulations. Above a pressure of 4 GPa the O-O structure factor is found to be very close to that of a simple soft sphere liquid, thus permitting us to determine the density of liquid water near the melting line. By comparing these results with the density of ice, also determined in this study, we find that the enthalpy of fusion (DeltaH(f)) increases enormously along the melting line, reaching approximately 120 kJ/mole at 40 GPa (compared to 6 kJ/mole at 0 GPa), thus revealing significant molecular dissociation of water upon melting. We speculate that an extended two-phase region could occur in planetary processes involving the adiabatic compression of water.

Melting curve and high-pressure chemistry of formic acid to 8 GPa and 600 K.

We have determined the melting temperature of formic acid (HCOOH) as a function of pressure to 8.5 GPa using infrared absorption spectroscopy, Raman spectroscopy and visual observation of samples in a resistively heated diamond-anvil cell. The experimentally determined incongruent melting curve compares favorably with a two-phase thermodynamic model. Decomposition reactions were observed above the melting temperature up to a pressure of 6.5 GPa, with principal products being CO2, H2O, and CO. At pressures above 6.5 GPa, decomposition led to reaction products that could be quenched as solids to zero pressure, and infrared and Raman spectra indicate that pressure leads to the presence of sp3 carbon-carbon bonding in these reaction products.