Clinical Research Directory

Inclusion Criteria: Patients who have: 1. Type 2 Diabetes (on diet, oral hypo-glycemic agents and/or insulin) or pre-diabetes (defined by Diabetes Canada as HbA1C=6.0-6.45% or increased fasting blood sugar (FBS) (6.1-6.9 mmol/L) or impaired glucose tolerance); 2. suffered a recent cardiovascular event (≤120 days post ACS (i.e. STEMI or nonSTEMI) or TIA/stroke with associated large vessel atherosclerotic disease confirmed on US, CT or MRI; 3. stable symptoms and hemodynamics; 4. age ≥18 years; 5. given informed consent. Standard definitions will be used for STEMI, NSTEMI, and for ischemic stroke confirmed by CT or MRI and TIA confirmed by a neurologist. Exclusion Criteria: Patients who have 1. planned revascularization of infarct or stroke related artery more than 120 days after the qualifying/index event; 2. a recent CV event likely to have been embolic in the opinion of the neurologist or cardiologist; 3. recent CV event likely to have been secondary to myocardial infarction with non-obstructive coronary arteries (MINOCA) in the opinion of the cardiologist; 4. severe LV dysfunction (EF\<30%); 5. severe valve disease requiring intervention; 6. decompensated heart failure; 7. active infection (e.g. pneumonia, active skin infections, and on antibiotics); 8. chronic diarrhea; 9. immune compromise (e.g. recurrent infection); 10. history of cancer within the last 3 years (other than a successfully treated cutaneous squamous cell or basal cell carcinoma or localized carcinoma in situ of the cervix). 11. active inflammatory conditions (e.g. rheumatoid arthritis, chronic inflammatory bowel disease, SLE, systemic anti-inflammatory therapy (e.g. prednisone, methotrexate)); 12. pregnancy (all women of child bearing potential will have a negative BHCG test; 13. breastfeeding; 14. Women of childbearing potential who refuse to use two forms of contraception (this includes at least one form of highly effective and one effective method of contraception) throughout the study OR men capable of fathering a child who refuse to use contraception. 15. glomerular filtration rate (GFR) \<50 ml/min/1.72m2 16. Use of potent p-glycoprotein inhibitors (i.e. systemic cyclosporine, clarithromycin, or systemic ketoconazole) or a strong CYP3A4 inhibitor (i.e. ritonavir, clarithromycin, or systemic ketoconazole); 17. Hemoglobin \< 105(women) \<110 (men) g/L; WBC \< 3.0x 10(9)/L, platelet count\< 110x 10(9)/L; 18. Patient with a history of cirrhosis, chronic active hepatitis or severe hepatic disease or with alanine aminotransferase (ALT) levels greater than 3 times the upper limit of normal. 19. unable to give informed consent; 20. TIA/Stroke patients with atrial fibrillation Exclusion for CTA portion of the protocol: Patients with dye allergy or those with GRF \<60 will not undergo CTA but will have PET/CT.