https://doi.org/10.1177/1479164117703034 Diabetes & Vascular Disease Research 2017, Vol. 14(4) 345–352 © The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1479164117703034 journals.sagepub.com/home/dvr Introduction Endothelial-derived fibrinolytic factors such as plasmino- gen activator inhibitor-1 (PAI-1) antigen, tissue plasmi- nogen activator antigen (tPAag), tissue plasminogen activator/plasminogen activator inhibitor-1 (tPA/PAI-1) complex and the haemostatic factor, von Willebrand factor (vWF), are known predictors of myocardial infarction and stroke. 1–4 They are also related to dysglycaemia. Thus, PAI-1 levels are correlated with the levels of glucose, 5–7 and PAI-1, tPAag and vWF all predict type 2 diabetes. 8 The effect of basal insulin glargine on the fibrinolytic system and von Willebrand factor in people with dysglycaemia and high risk for cardiovascular events: Swedish substudy of the Outcome Reduction with an Initial Glargine Intervention trial Aslak Rautio 1,2 , Kurt Boman 1,3 , Hertzel C Gerstein 4 , Jenny Hernestål-Boman 1,3 , Shun Fu Lee 4 , Mona Olofsson 1,3 and Linda Garcia Mellbin 5 Abstract Introduction: Fibrinolytic factors, plasminogen activator inhibitor-1, tissue plasminogen activator, tissue plasminogen activator/plasminogen activator-complex and the haemostatic factor von Willebrand factor are known markers of cardiovascular disease. Their plasma levels are adversely affected in patients with dysglycaemia, and glucose normalization with insulin glargine might improve the levels of these factors. Methods: Prespecified Swedish substudy of the Outcome Reduction with an Initial Glargine Intervention trial (ClinicalTrials. gov number, NCT00069784). Tissue plasminogen activator activity, tissue plasminogen activator antigen, plasminogen activator inhibitor-1 antigen, tissue plasminogen activator/plasminogen activator inhibitor-1 complex and von Willebrand factor were analysed at study start, after 2 years and at the end of the study (median follow-up of 6.2 years). Results: Of 129 patients (mean age of 64 ± 7 years, females: 19%), 68 (53%) and 61 (47%) were randomized to the insulin glargine and standard care group, respectively. Allocation to insulin glargine did not significantly affect the studied fibrinolytic markers or von Willebrand factor compared to standard care. Likewise, there were no significant differences in plasminogen activator inhibitor-1, tissue plasminogen activator antigen and von Willebrand factor. During the whole study period, the within-group analysis revealed a curvilinear pattern and significant changes for tissue plasminogen activator/plasminogen activator inhibitor-1 complex, tissue plasminogen activator antigen and von Willebrand factor in the insulin glargine but not in the standard care group. Conclusion: In people with dysglycaemia and other cardiovascular risk factors, basal insulin does not improve the levels of markers of fibrinolysis or von Willebrand factor compared to standard glucose-lowering treatments. Keywords Diabetes, insulin glargine, glucose-lowering treatment, fibrinolysis 1 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden 2 Department of Medicine, Sunderby Hospital, Luleå, Sweden 3 Research Unit, Skellefteå Hospital, Skellefteå, Sweden 4 Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada 5 Unit of Cardiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden Corresponding author: Aslak Rautio, Department of Medicine, Sunderby Hospital, 971 80 Luleå, Sweden. Email: aslak.rautio@nll.se 0010.1177/1479164117703034Diabetes & Vascular Disease ResearchRautio et al. research-article 2017 Original Article