Aggressive Treatments Don't Help Diabetes Patients

March 15, 2010 (Atlanta) -- Lowering blood pressure and blood fat levels to
below current guidelines did not bring down higher risks of heart problems for
diabetes patients, according to new results from a landmark federal study.
But for individual people with diabetes, the findings brought some good news
in that the current standard of care worked better than expected, some doctors
say. Also, for people with diabetes that are at particularly heightened risk of
heart problems, aggressive management may still be needed, they point out.
Overall, the findings underscore the need for most people with diabetes to
focus on healthy diets and lifestyles as well as to take the medications their
doctors recommend to improve heart health, some experts tell WebMD.
The experts are reacting to results from the Action to Control
Cardiovascular Risk in Diabetes (ACCORD) trial, launched 10 years ago to
determine whether aggressively lowering blood sugar, blood pressure, and blood
fat would reduce heart attacks and strokes in people with diabetes.
The new results show that lowering systolic blood pressure -- the top number
-- to 120 rather than the usual recommended 140 did not lower heart attacks,
strokes, or death from cardiovascular causes, reports William Cushman, MD, of
the VA Medical Center in Memphis, Tenn.
Similarly, adding the fat-busting drug TriCor to standard
cholesterol-lowering drugs called statins did not reduce the odds of heart
attacks, strokes, or death from cardiovascular causes, says Henry Ginsberg, MD,
of Columbia University in New York City. TriCor is a fibrate, designed to lower
triglycerides while boosting HDL "good" cholesterol.
The studies were presented at the American College of Cardiology meeting and
released simultaneously online by The New England Journal of
Medicine.
A third part of the research -- about intensive lowering of blood sugar --
was prematurely halted two years ago when it turned out that the approach was
associated with an increased, not decreased, risk of death.
Aggressive Therapy and Heart Risks
The blood pressure portion of ACCORD involved 4,733 people with diabetes at
high risk of heart disease or stroke. They were given a variety of medications
to keep their systolic blood pressure under 120 or under 140.
The overall rate of heart attacks, strokes, and deaths was similar among the
two groups. People who got the aggressive treatment had fewer strokes, but the
absolute number of strokes was quite low, Cushman says.
A total of 3.3% of people on intensive treatment suffered serious side
effects such as dangerously low blood pressure or kidney failure vs. 1.3% in
the standard therapy group.
The lipid portion of ACCORD included 5,518 patients at high risk of heart
problems. They were given either TriCor plus statins or a placebo plus
statins.
As expected, triglyceride levels dropped more and HDL levels increased more
in the group that got TriCor. But people who got TriCor were no less likely to
have heart attacks, strokes, or die from heart problems.
Planned analyses of subgroups of patients suggested "a possible benefit" for
people with high triglyceride and low HDL levels to start with -- the very
people whom fibrate drugs are designed to help, Ginsberg says.
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