Eighteen of the 30 strokes were fatal in the conventional group, and all 6 were fatal in the inten- sive group. Meschia et al Guidelines for the Primary Prevention of Stroke 3769 In the Euro Heart Survey on Diabetes and the Heart, 3488 patients were enrolled, 59% without and 41% with diabetes Evidence-based medicine was defined as the com- bined use of renin-angiotensin-aldosterone system inhibitors, -adrenergic receptor blockers, antiplatelet agents, and statins. In patients with diabetes mellitus, the use of evidence-based independent protective effect on 1-year mortality and on car- compared with those without diabetes mellitus. Although stroke rates were not changed, there was an 50% reduction in cerebrovascular revascularization procedures. Glycemic Control The effect of previous randomization of the UK Prospective Diabetes Study (UKPDS)290 to either conventional therapy (dietary restriction) or intensive therapy (either sulfonylurea or insulin or, in overweight patients, metformin) for glucose control was assessed in an open-label extension study. In post- trial monitoring, 3277 patients were asked to attend UKPDS clinics annually for 5 years; however, there were no attempts to maintain their previously assigned therapies.291 A reduction in MI and all-cause mortality was found; however, stroke inci- dence was not affected by assignment to either sulfonylurea/ insulin or metformin treatment. Three major recent trials have evaluated the effects of reduced glycemia on CVD events in patients with type 2 dia- betes mellitus. The ACCORD recruited 10251 patients (mean age, 62 years) with a mean glycated hemoglobin of 8.1%.292 Participants were then randomized to receive intensive (gly- cated hemoglobin goal, <6.0%) or standard (goal, 7.0% 7.9%) therapy. The study was stopped earlier than planned because of an increase in all-cause mortality in the intensive therapy group with no difference in the numbers of fatal and nonfatal strokes. 