BP, Cholesterol, & Brain Health With Diabetes
Study found no effect, but longer-term trials may be needed to see a benefit, experts add
By E.J. Mundell
TUESDAY, Feb. 4, 2014 (HealthDay News) -- It's well known that having type 2 diabetes can increase a person's chances of impaired memory and thinking. But a new study suggests that intensive treatment of blood pressure and cholesterol levels in people with diabetes won't help lower that risk.
"The finding that intensive blood pressure lowering did not impact [mental] decline in patients with diabetes seems to be consistent with recent trials in patients with diabetes that [showed that] lower is not necessarily better," said one expert, Dr. Kevin Marzo, chief of cardiology at Winthrop-University Hospital in Mineola, N.Y. Marzo was not involved in the new research.
The study, published online Feb. 3 in the journal JAMA Internal Medicine, tracked outcomes for nearly 3,000 people with type 2 diabetes who had no deficits in memory or thinking and showed no other signs of dementia at the beginning of the study.
The patients had taken part in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Some of them got "intensive" therapy to lower their systolic blood pressure -- the top number in a reading -- to below 120 millimeters of mercury (mm/Hg), while a comparison group got "standard" blood pressure therapy with a goal of lower than 140 mm/Hg.
Other patients in the trial received intensive therapy to battle high cholesterol, which meant adding a fibrate drug to a statin medication to try to bring blood cholesterol levels to below 100 milligrams per deciliter. A comparison group got standard cholesterol treatment -- the statin alone -- plus a placebo.
After more than three years of follow-up, the researchers, led by Dr. Jeff Williamson of the Wake Forest School of Medicine, said they observed no differences in the mental function of people who got intensive therapies versus those who got the standard treatments.
The researchers also looked at the total brain volume of some people in each group, because lessening brain volume has been linked to mental decline.
People in the intensive blood-pressure-lowering group seemed to have less reduction in brain volume than those who got standard blood pressure care, Williamson's team found. Adding the fibrate drug to cholesterol care appeared to have no impact on brain volume, however.
The study authors said there has been a lot of attention given to the possibility that better control of blood pressure and cholesterol might help people with diabetes avoid mental decline.
But although these types of treatments might be helpful for people with heart disease or stroke, the researchers said, the current study showed no overall reduction in the rate of mental decline linked to type 2 diabetes after intensive blood pressure and cholesterol control.
Other experts in diabetes and its relationship to heart health said more research might be necessary, however.