Prevention of Cardiovascular Disease in Persons with Type 2 Diabetes Mellitus: Current Knowledge and Rationale for the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial

• Published in: The American journal of cardiology 2007-06, Vol.99 (12), p.S4-S20
• Main Authors: Goff, David C., MD, PhD, Gerstein, Hertzel C., MSc, MD, Ginsberg, Henry N., MD, Cushman, William C., MD, Margolis, Karen L., MPH, MD, Byington, Robert P., MPH, PhD, Buse, John B., MD, PhD, Genuth, Saul, MD, Probstfield, Jeffrey L., MD, Simons-Morton, Denise G., MD, PhD
• Format: Article
• Language: English
• Subjects: Antihypertensive Agents - administration & dosage; Antihypertensive Agents - therapeutic use; Blood pressure; Cardiology; Cardiovascular; Cardiovascular disease; Coronary Disease - blood; Coronary Disease - prevention & control; Diabetes; Diabetes Mellitus, Type 2; Diabetic Angiopathies - blood; Diabetic Angiopathies - prevention & control; Disease management; Fenofibrate - administration & dosage; Fenofibrate - therapeutic use; Glucose; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hypolipidemic Agents - administration & dosage; Hypolipidemic Agents - therapeutic use; Lipids; Randomized Controlled Trials as Topic
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2007.03.002

Patients with type 2 diabetes mellitus die of cardiovascular disease (CVD) at rates 2–4 times higher than patients without diabetes but with similar demographic characteristics. The prevalence of diabetes is increasing in the United States and, thus, the prevention of CVD in patients with diabetes poses an urgent public health challenge. The objective of this report is to review the current knowledge base for the prevention of CVD in patients with diabetes, with particular emphasis on the control of glycemia, lipids, and blood pressure. Epidemiologic analyses suggest that each 1% increase in glycosylated hemoglobin increases the risk for CVD by approximately 18%; however, evidence from the randomized trials that have examined whether glucose lowering reduces this risk is conflicting. Randomized trials have shown that lowering low-density lipoprotein cholesterol reduces CVD event rates by 17%–43% in patients with diabetes. Limited data support a role for lowering triglycerides and increasing high-density lipoprotein cholesterol in the prevention of CVD. Evidence from clinical trials shows that reducing systolic blood pressure to