Type 2 diabetes — PPAR-alpha (fenofibrate added to simvastatin)

Extended-release niacin with laropiprant, added to statin therapy, would reduce major vascular events by further lowering LDL and raising HDL cholesterol.

In 25,673 adults with vascular disease over a median 3.9 years, major vascular events occurred in 13.2% on niacin-laropiprant vs 13.7% on placebo (rate ratio 0.96, P=0.29), while serious disturbances of diabetes control rose by 3.7 percentage points.

Why it matched: same research area · similar wording · mechanism: Lipid & cholesterol handling

Spironolactone, which improves outcomes in heart failure with reduced ejection fraction, would do the same in heart failure with preserved ejection fraction.

In 3,445 patients with ejection fraction of 45% or more over a mean 3.3 years, the primary composite (cardiovascular death, aborted cardiac arrest or heart-failure hospitalization) occurred in 18.6% vs 20.4% on placebo (HR 0.89, P=0.14). Hyperkalemia doubled (18.7% vs 9.1%).

Why it matched: same research area · similar wording

Twelve weeks of endurance exercise, vitamin D, or both would reduce insulin resistance (HOMA-IR) in middle-aged adults with type 2 diabetes.

Across 61 participants randomised to control, exercise, vitamin D or both, none of the interventions improved HOMA-IR, the primary outcome; only fasting glucose fell in the combined group (−11.9%).

Why it matched: same research area

Lowering LDL cholesterol with statins, especially to very low levels, would change cancer risk.

In individual data from 175,000 people in 27 trials, about 5 years of statin therapy had no effect on cancer incidence (RR 1.00) or cancer death (RR 1.00), at any of 23 cancer sites, for any statin, or in people who started with low LDL.

Why it matched: similar wording · mechanism: Lipid & cholesterol handling

Clearing the parasite with benznidazole in patients with established Chagas cardiomyopathy would slow cardiac clinical deterioration.

Among 2,854 patients followed a mean 5.4 years, the composite cardiac outcome occurred in 27.5% vs 29.1% on placebo (HR 0.93, P=0.31).

Why it matched: similar wording