by Colin Kenny, GP, Dromore
The ACCORD (Action to Control Cardiovascular Risk in Diabetes) study began in 1999 and enrolled 10,251 people with type 2 diabetes aged 40–79 years who were at high risk of cardiovascular (CV) events. Participants were randomised into two HbA1c groups, with goals of <42 mmol/mol (<6.0%) and 53–63 mmol/mol (7.0–7.9%), and then split into a lipid sub-trial (n=5518) and a blood pressure (BP) sub-trial (n=4733) and randomised a second time. In the lipid sub-trial, participants were randomised to a systolic BP goal of <120 mmHg (intensive BP) or <140 mmHg (standard BP); in the BP sub-trials randomisation was to simvastatin plus fenofibrate (intensive lipid) or simvastatin plus placebo (standard lipid). The primary outcomes was a composite of CV death, non-fatal myocardial infarction and non-fatal stroke.
We know that the intensive glucose-lowering arm was stopped in 2008 (because of an unexpected increase in total deaths from any cause), with those participants being transitioned to the standard glucose control strategy. The blood pressure and lipid treatment sub-trials continued. Consenting participants have continued to be followed regularly to determine whether any differences seen during the ACCORD study in outcomes persisted, and these data have now been published.
The results tell us that risks for the primary outcome in the BP sub-trial were lower in groups intensively treated for glycaemia, BP or both compared with combined standard BP and glycaemia treatment. Among secondary outcomes, myocardial infarction was significantly reduced by intensive glycaemia treatment and stroke by intensive BP treatment.
In the lipid sub-trial, the general pattern of results showed no evidence of benefit of intensive regimens compared with combined standard lipid and glycaemia treatment.
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