[Multirisk approach of the type 2 diabetic patient: controversies surrounding target values after the ACCORD trial].
The ACCORD trial investigated the effects of intensifying the global management of 10,251 type 2 diabetic patients, with established cardiovascular disease or at least two other cardiovascular risk factors, on a composite endpoint (non fatal myocardial infarction, stroke and cardiovascular death). The attempt to reduce HbA1c level below 6% was associated with an increased cardiovascular mortality (despite a reduction in non fatal myocardial infarcts); lowering systolic blood pressure below 120 mmHg instead of 140 mmHg did not provide any additional benefit; finally, the control of atherogenic dyslipidaemia, with fenofibrate added to a statin, did not modify the composite endpoint (despite a positive effect in the subgroup of patients with high triglycerides and low HDL cholesterol). These rather disappointing results should be interpreted to provide practical guidelines.
Scheen
André J
AJ
Service de diabétologie, nutrition et maladies métaboliques et Unité de pharmacologie clinique, Département de médecine, CHU Sart Tilman, 4000 Liege, Belgique. andre.scheen@chu.ulg.ac.be
Paquot
Nicolas
N
D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008055:Lipids / Q000097:blood
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008055:Lipids; C517652:hemoglobin A1c protein, human