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Diabetes Study Sparks Treatment Debate

Is Aggressive Lowering of Blood Pressure, Cholesterol OK for Hearts of Diabetes Patients?

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 debate.

"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 treatment?

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."

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