April 8, 2008 -- Diabetes patients who used medicine to lower their
cholesterol and blood pressure to below target levels displayed improvements in
several important markers of heart and vascular disease, a study shows. But the
patients were just as likely as less aggressively treated patients to have
heart attacks and strokes.
The study appears in the April 9 edition of The Journal of the American
Heart disease is the leading cause of death in adults with diabetes. There
has been much debate about how much to reduce systolic blood pressure (SBP) and
LDL "bad" cholesterol readings in these high-risk patients.
In one of the first controlled trials to address the issue, researchers
randomly assigned 499 middle-aged American Indians with type 2 diabetes to
treatment aimed at reaching either standard blood pressure and lipid targets
(LDL of no more than 100mg/DL and SBP of no more than 130 mm Hg) or more
aggressive lowering of these levels (LDL of no more than 70 mg/dL and SBP of no
more than115 mm Hg).
The patients were all obese (BMI range of 32-34, normal <25); two-thirds
Aggressive Treatment vs. Standard Treatment
Over the course of the trial, the more aggressively treated patients
experienced regression of plaque buildup in neck arteries (not seen in the
standard treatment group), and greater improvement in heart muscle thickening,
researcher Barbara V. Howard, PhD, tells WebMD.
Both treatment groups also had far fewer heart attacks and strokes than
would have been expected without treatment.
But no advantage was seen for aggressive lowering of LDL and SBP in terms of
heart attack and stroke incidence. And patients treated to lower SBP
targets experienced more side effects related to their blood pressure
Howard tells WebMD that the study's relatively small sample size and short
duration of follow-up may explain the failure to demonstrate a difference in
outcomes among the two groups.
"My educated guess is that we will see a difference when we continue to
follow these patients," she says. "Our study suggests that these lower
targets could bring benefits, but we need more research to really understand
the risks vs. benefits of this strategy."
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