Skip to comments.Aggressive Treatments Don't Help Diabetes Patients - Heart Risk Isn't Cut for Diabetes Patients...
Posted on 03/16/2010 3:53:03 PM PDT by neverdem
Reviewed by Laura J. Martin, MD
Heart Risk Isn't Cut for Diabetes Patients Who Aggressively Lower Blood Pressure, Blood Fats
March 15, 2010 (Atlanta) -- Lowering blood pressure and blood fat levels to below current guidelines did not bring down higher risks of heart problems for diabetes patients, according to new results from a landmark federal study.
But for individual people with diabetes, the findings brought some good news in that the current standard of care worked better than expected, some doctors say. Also, for people with diabetes that are at particularly heightened risk of heart problems, aggressive management may still be needed, they point out.
Overall, the findings underscore the need for most people with diabetes to focus on healthy diets and lifestyles as well as to take the medications their doctors recommend to improve heart health, some experts tell WebMD.
The experts are reacting to results from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, launched 10 years ago to determine whether aggressively lowering blood sugar, blood pressure, and blood fat would reduce heart attacks and strokes in people with diabetes.
The new results show that lowering systolic blood pressure -- the top number -- to 120 rather than the usual recommended 140 did not lower heart attacks, strokes, or death from cardiovascular causes, reports William Cushman, MD, of the VA Medical Center in Memphis, Tenn.
Similarly, adding the fat-busting drug TriCor to standard cholesterol-lowering drugs called statins did not reduce the odds of heart attacks, strokes, or death from cardiovascular causes, says Henry Ginsberg, MD, of Columbia University in New York City. TriCor is a fibrate, designed to lower triglycerides while boosting HDL "good" cholesterol.
The studies were presented at the American College of Cardiology meeting and released simultaneously online by The New England Journal of Medicine.
A third part of the research -- about intensive lowering of blood sugar -- was prematurely halted two years ago when it turned out that the approach was associated with an increased, not decreased, risk of death.
Aggressive Therapy and Heart Risks The blood pressure portion of ACCORD involved 4,733 people with diabetes at high risk of heart disease or stroke. They were given a variety of medications to keep their systolic blood pressure under 120 or under 140.
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.
"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 step 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.
"Nature says high blood pressure is not good," he says.
And never stop taking medication without checking with your doctors, the experts say.
Abbott, which makes TriCor, released a statement that the findings "support the appropriate patient type and current treatment guidelines for fibrates. The top-line results of the study were widely expected, given that two-thirds of patients in the trial would not be recommended for fibrate therapy under current guidelines."
FReepmail me if you want on or off the diabetes ping list.
I’ver never had high BP or been overweight.
I’m going to die from trying to figure this all out. How about summing it in 10 words or less!! Jeeesh...
With diabetes, cholesterol meds don't lessen chances of heart attack.
My BP is often low and today they cut my metropolol in half. I’ve been on dialysis for 6 years and received a kidney in Nov. It’s been a terrible journey to get it to working correctly. I gained over 40 lbs. of fluid, got water blisters on my legs and feet, two blood infections, etc. I often wish I hadn’t gone throgh it but am getting better in some areas. I had two heart attacks earlier. Thanks for posting this. I’m also diabetic.
With diabetes, cholesterol meds don't lessen chances of heart attack.
No, and if medicine was that simple, docs wouldn't have needed so much training. AP wrote this story yesterday, but CBS's title for it is misleading. I didn't see it when I first looked for it today, so I went with the Web MD version.
Here's the first paragraph:
Key results from a landmark federal study are in, and the results are disappointing for diabetics: Adding drugs to drive blood pressure and blood-fats lower than current targets did not prevent heart problems, and in some cases caused harmful side effects.
Keep reading the whole story. Adding TriCor appeared to help men, but "appeared to possibly harm women, by raising the chance they would suffer a heart problem compared to women taking dummy pills."
I'm a doc. From what I've read, keeping yourself mentally challenged reduces the risk of dementia.
Adding fibrates to statins or an additional hypertension medication to the primary hypertension medication doesn’t decrease the frequency of cardiac events for diabetic TYPE II patients, may even make them worse. The initial cholesterol or BP drug DOES help (or so I remember from the LA Times version of the article a few days ago). Took a few more than 10 words in my synopsis.
I read the whole article because I was interested in it and had the time.
Dokmad wanted 10 words or less so I chose the clearest description that didn’t seem misleading.
Some people need to get right to the point, some people like all the details. We need to satisfy both.
That is correct.
I’m not sure this should be asked here but,,,,,,,, my doctor just gave me a prescription for Pravachol. It is sitting on my desk untaken. Unfortunately I looked on the internet and wow, many bad side effects. Trouble is I don’t know if that is quite common, common, not so common, rare or hardly ever.
Secondly is has been reported that Pravachol itself is better than the generic and I have the generic. Anybody here taking either? And if so any side effects.
After having serious trouble with statins I stopped taking them and my GP wasn't too happy but my endo suggested several alternatives.
Fish oil, 2 tablespoons of Benecol (butter-like bread spread), walnuts and some other foods have slowly lowered mine.
There's also Niacin. Gives you hot flashes after taking but I think you only take one a day. A friend takes that and his dr. is satisfied with his results.
PC: You don't know till you try it.
UNPC: The dozen people I polled had undesirable side effects from statins. No one I asked was still taking them.
Thank you for the reply and adding to my concern. :<(((
You should try it. You might be one who can take it.
If you feel it’s bothering you stop taking it and wait for the symptoms to go away. I took it for 3 weeks, developed distinct problems and quit it. It took about 3 weeks for the symptoms to pass. Tell your doctor.
It’s those who try to bully it through that chance worse issues. You are safe to try it.
I’m diabetic and take statins as well as insulin (Lantus). I also supplement with DHEA and Chromium Picolinate. These seem to work pretty well for me. Everyday though, long and contradictory articles and information comes out about what works and does not work for Diabetics. It’s mind boggling at best. Thanks for everyones comments tho.
Allen In Texas Hill Country, have you started taking yours yet?
Yes, and marked it on the calendar. I found one web site that wasn’t so negative and talked to the pharmacist. We’ll see.
You are exactly right. Lowering the numbers merely lowers the numbers. It does not treat the underlying disease. We’ve all been sold a bill of goods, or at least a ton of pills and test strips.