Aggressive Treatments Don't Help Diabetes Patients
Heart Risk Isn't Cut for Diabetes Patients Who Aggressively Lower Blood Pressure, Blood Fats
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Aggressive Therapy and Heart Risks continued...
The overall rate of heart attacks, strokes, and deaths was similar among the two groups. People who got the aggressive treatment had fewer strokes, but the absolute number of strokes was quite low, Cushman says.
A total of 3.3% of people on intensive treatment suffered serious side effects such as dangerously low blood pressure or kidney failure vs. 1.3% in the standard therapy group.
The lipid portion of ACCORD included 5,518 patients at high risk of heart problems. They were given either TriCor plus statins or a placebo plus statins.
As expected, triglyceride levels dropped more and HDL levels increased more in the group that got TriCor. But people who got TriCor were no less likely to have heart attacks, strokes, or die from heart problems.
Planned analyses of subgroups of patients suggested "a possible benefit" for people with high triglyceride and low HDL levels to start with -- the very people whom fibrate drugs are designed to help, Ginsberg says.
Lowering Blood Pressure Still Important
"I'm not surprised that [TriCor] did not benefit all diabetics," says Paul D. Thompson, MD, chief of cardiology at Hartford Hospital, Conn. He was not involved with the study.
"I think of it as a drug for increasing HDL and lowering triglycerides," he says, and such patients would be expected to continue to benefit.
The findings point to the need for individualized therapy, agrees Clyde Yancy, MD, a cardiologist at Baylor University in Dallas who is president of the American Heart Association.
Overall, patients in all the groups faced about a 2% risk of having a heart attack, stroke, or dying of cardiovascular disease a year -- regardless of whether they got intensive or standard blood-pressure lowering or a fibrate plus statin or a statin alone, he notes.
That's "better than expected [for high-risk diabetes patients]," Yancy says.
So what should people with diabetes do? Focus on maintaining a healthy weight, eating right, exercising, and taking other lifestyle steps proven to reduce heart risks, he says.
W. Douglas Weaver, MD, of the Henry Ford Health System in Detroit and a past American College of Cardiology president, stresses that the findings do not negate the need to keep blood pressure and blood fats under control.