Two therapies don’t cut risk of heart attack

By Communications staff, Washington State University
Lowering blood pressure to normal levels – below currently recommended levels – did not significantly reduce the combined risk of fatal or nonfatal cardiovascular disease events in adults with type 2 diabetes who were at especially high risk for cardiovascular disease events, according to new results from the landmark Action to Control Cardiovascular Risk in Diabetes (ACCORD) clinical trial.
 
Similarly, treating multiple blood lipids with combination drug therapy of a fibrate and a statin did not reduce the combined risk of cardiovascular disease events more than treatment with statin alone.
 
The study of more than 10,000 participants is sponsored by the National Institutes of Health.
 
ACCORD is one of the largest studies ever conducted in adults with type 2 diabetes who were at especially high risk of cardiovascular events, such as heart attacks, stroke or death from cardiovascular disease.
 
An estimated 24 million Americans have diabetes, which is the seventh leading cause of death in the United States. Adults with type 2 diabetes are two to four times more likely than adults without diabetes to die from heart disease, and 65 percent of deaths in people with diabetes are from cardiovascular causes.

The multicenter ACCORD clinical trial tested three potential strategies to lower the risk of major cardiovascular events: intensive control of blood sugar, intensive control of blood pressure and treatment of multiple blood lipids. The lipids targeted for intensive treatment were high density lipoprotein (HDL) cholesterol and triglycerides, in addition to standard therapy of lowering low density lipoprotein (LDL) cholesterol.

The results of the ACCORD blood pressure and lipid clinical trials appear online in the New England Journal of Medicine (NEJM) and will be in the April 29 print edition. The results were presented at the American College of Cardiology’s 59th annual scientific session in Atlanta in March. Results of the ACCORD blood sugar clinical trial were reported in 2008.

“ACCORD provides important evidence to help guide treatment recommendations for adults with type 2 diabetes who have had a heart attack or stroke or who are otherwise at especially high risk for cardiovascular disease,” said Susan Shurin, acting director of the NIH’s National Heart, Lung and Blood Institute (NHLBI), the primary sponsor of ACCORD. “This information provides guidance to avoid unnecessarily increasing treatment that provides limited benefit and potentially increases the risk of adverse effects.”

ACCORD researchers from 77 medical centers in the United States and Canada (including the clinical trials research team at WSU Spokane) studied 10,251 participants between the ages of 40 and 79 who had type 2 diabetes for an average of 10 years. When they joined the study, all participants were at especially high risk of cardiovascular events because they had pre-existing cardiovascular disease, evidence of subclinical cardiovascular disease, or at least two cardiovascular disease risk factors in addition to diabetes.

All participants were enrolled in the ACCORD blood sugar treatment clinical trial and maintained good control of blood sugar levels during the study. In addition, participants were enrolled in either the blood pressure trial or the lipid trial and were treated and followed for an average of about five years.

* Read the full NIH news release
* Read the NEJM article, “Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus”
* Read the NEJM article,”Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus”
* Read the Aug 2009 story about the Spokane ACCORD trial