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Correspondence

Effect of Basal Insulin Glargine on First and Recurrent Episodes of Heart Failure Hospitalization

The ORIGIN Trial (Outcome Reduction With Initial Glargine Intervention)

Hertzel C. Gerstein, Hyejung Jung, Lars Rydén, Rafael Diaz, Richard E. Gilbert, Salim Yusuf
and On behalf of the ORIGIN Investigators
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https://doi.org/10.1161/CIRCULATIONAHA.117.030924
Circulation. 2018;137:88-90
Originally published December 26, 2017
Hertzel C. Gerstein
Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (H.C.G., H.J., S.Y.)
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Hyejung Jung
Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (H.C.G., H.J., S.Y.)
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Lars Rydén
Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (L.R.)
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Rafael Diaz
Estudios Clínicos Latino América, Rosario, Argentina (R.D.)
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Richard E. Gilbert
St Michael’s Hospital, University of Toronto, Ontario, Canada (R.E.G.).
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Salim Yusuf
Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (H.C.G., H.J., S.Y.)
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  • heart failure
  • hospitalization
  • insulin glargine

Diabetes mellitus increases the incidence of recurrent heart failure through a variety of potential mechanisms, including ischemic myocardial damage, hyperglycemia, and the effects of the glucose-linked metabolic abnormalities on the myocardium.1 To date, randomized controlled trials of more versus less glucose lowering with a menu of drugs, including insulin, have reported a neutral effect on incident heart failure. Nevertheless, epidemiological studies and the sodium-retaining properties of insulin have fueled concerns about a possible link.2

The ORIGIN trial (Outcome Reduction With Initial Glargine Intervention) allocated 12 537 people (mean age, 64 years; 35% women) with diabetes mellitus (88%), impaired glucose tolerance, or impaired fasting glucose to either basal insulin-mediated normoglycemia or therapy without insulin and reported a neutral effect on cardiovascular events during a median follow-up of 6.2 years. People with New York Heart Association class 3 or 4 heart failure were excluded. Heart failure requiring hospitalization was a prespecified component of the primary outcome and was defined as evidence of overnight hospitalization or attendance in an acute care setting for at least 2 of the following: signs or symptoms of heart failure; radiological evidence of congestive heart failure; treated with intravenous diuretics, or a first or increased dose of an oral diuretic, intravenous or oral vasodilator, or intravenous or oral inotrope.3 Both first and recurrent episodes were prospectively collected and …

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January 2, 2018, Volume 137, Issue 1
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    Effect of Basal Insulin Glargine on First and Recurrent Episodes of Heart Failure Hospitalization
    Hertzel C. Gerstein, Hyejung Jung, Lars Rydén, Rafael Diaz, Richard E. Gilbert and Salim Yusuf On behalf of the ORIGIN Investigators
    Circulation. 2018;137:88-90, originally published December 26, 2017
    https://doi.org/10.1161/CIRCULATIONAHA.117.030924

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    Effect of Basal Insulin Glargine on First and Recurrent Episodes of Heart Failure Hospitalization
    Hertzel C. Gerstein, Hyejung Jung, Lars Rydén, Rafael Diaz, Richard E. Gilbert and Salim Yusuf On behalf of the ORIGIN Investigators
    Circulation. 2018;137:88-90, originally published December 26, 2017
    https://doi.org/10.1161/CIRCULATIONAHA.117.030924
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