Diabetes Study Sparks Treatment Debate
Is Aggressive Lowering of Blood Pressure, Cholesterol OK for Hearts of Diabetes Patients?
WebMD News Archive
How Low Should You Go?
These findings appear certain to add to the debate within preventive
cardiology about how low to go in reducing cardiovascular risk factors like
high blood pressure, LDL cholesterol, and high blood sugar in diabetic and
other high-risk populations.
The debate hit the front pages of the nation's newspapers early in February
when findings from the 10,000-person ACCORD study suggested that rather than
reducing heart attack and stroke deaths, intensive blood sugar lowering may
increase such risks among people with type 2 diabetes.
"We have basically taken as gospel that if we change risk factors [like
LDL, blood pressure, and blood sugar] good things will happen," Duke
University Medical Center cardiologist Eric D. Peterson, MD, tells WebMD.
"Studies like ACCORD and this one suggest that modifying risk factors alone
may not ensure better outcomes."
In an editorial accompanying the study by Howard and colleagues, Peterson
writes that the findings should give ammunition to both sides of the
"For the true believers, the study confirms that aggressive lipid and
hypertension treatment has a favorable effect on proven 'early markers' of
disease," he writes. "Thus, with longer duration of follow-up the study
would most assuredly demonstrate improved patient outcomes."
But for those he terms the "therapeutic nihilists" the findings once
again fail to show a clear advantage for very aggressive treatment.
So what is the message to patients and their physicians about aggressive
Peterson tells WebMD that there appears to be little downside to lowering
LDL cholesterol to very low levels with statins, but the jury is still out on
aggressive blood pressure lowering.
"We really do have good data showing the benefits of aggressive
cholesterol lowering with statins," he says. "It's a safe assumption
that the benefits are great and the risks are low. But that isn't clear yet
with aggressive blood pressure lowering. We can't say that the benefits
outweigh the risks."