Compared with combined standard treatment options, intensive blood pressure or intensive glycemia treatment alone were shown to improve major cardiovascular outcomes in patients with type 2 diabetes with no additional benefit found with combining the two treatments, in an analysis of the Action to Control Cardiovascular Risk in Diabetes, or ACCORD, blood pressure trial. In the ACCORD lipid trial, researchers found that intensive glycemia treatment was shown to increase mortality.
“In patients with longstanding type 2 diabetes and high CVD risk resembling those in the ACCORD lipid trial, these analyses do not support adding fenofibrate to a statin, intensive glycemia control, or the combination. In patients similar to those enrolled in the ACCORD BP trial, these analyses provide limited support for intensive BP control and even more limited support for intensive glycemia control to reduce the risk of major CVD. Any kind of treatment intensification requires more visits and medications and exposure to adverse effects, but intensifying BP control in patients with diabetes may be less risky than intensifying glycemia control, which reduced [myocardial infarction] but was associated with increased mortality in some patients,” the researchers wrote.
In the ACCORD trial, researchers looked at treatment of glycemia and either BP or lipids and compared the effects of combinations of both standard and intensive treatments in the management risk for CVD events in patients with type 2 diabetes.
Researchers analyzed data for 10,251 patients with type 2 diabetes who were enrolled in the ACCORD trial. The patients ranged in age from 40 to 79 years and were all at high risk for CVD events.
Patients were randomly assigned to intensive glycemia treatment or standard glycemia treatment. The patients were then randomly assigned a second time into two groups: intensive BP or standard BP treatments, intensive lipid or standard lipid treatments. The composite primary outcomes assessed were deaths due to CVD, nonfatal MI and nonfatal stroke. The researchers used proportional hazards models assess the combinations of treatments.
Compared with combined standard BP and glycemia treatment, the risk of the primary outcome in the BP trial was lower in the groups intensively treated for glycemia (HR=0.67; 95% CI, 0.5-0.91), BP (HR=0.74; 95% CI, 0.55-1), or both (HR=0.71; 95% CI, 0.52-0.96). Compared with combined standard lipid and glycemia treatment, in the lipid trial, no overall benefit was shown with the intensive regimens, single or combined.
Disclosure: Margolis reported no relevant financial disclosures. Other researchers reported financial relationships with industry. Please see study for full disclosures.