Outcomes of combined cardiovascular risk factor management strategies in type 2 diabetes

the accord randomized trial

Karen L. Margolis, Patrick J. O'Connor, Timothy M. Morgan, John B. Buse, Robert M. Cohen, William Cushman, Jeffrey A. Cutler, Gregory W. Evans, Hertzel C. Gerstein, Richard H. Grimm, Edward W. Lipkin, K. M.Venkat Narayan, Matthew C. Riddle, Ajay Sood, David C. Goff

Research output: Contribution to journalArticle

119 Citations (Scopus)

Abstract

OBJECTIVE To compare effects of combinations of standard and intensive treatment of glycemia and either blood pressure (BP) or lipids in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. RESEARCH DESIGN AND METHODS ACCORD enrolled 10,251 type 2 diabetes patients aged 40–79 years at high risk for cardiovascular disease (CVD) events. Participants were randomly assigned to hemoglobin A1c goals of <6.0% (<42 mmol/mol; intensive glycemia) or 7.0–7.9% (53–63 mmol/mol; standard glycemia) and then randomized a second time to either 1) systolic BP goals of <120 mmHg (intensive BP) or <140 mmHg (standard BP) or 2) simvastatin plus fenofibrate (intensive lipid) or simvastatin plus placebo (standard lipid). Proportional hazards models were used to assess combinations of treatment assignments on the composite primary (deaths due to CVD, nonfatal myocardial infarction [MI], and nonfatal stroke) and secondary outcomes. RESULTS In the BP trial, risk of the primary outcome was lower in the groups intensively treated for glycemia (hazard ratio [HR] 0.67; 95% CI 0.50–0.91), BP (HR 0.74; 95% CI 0.55–1.00), or both (HR 0.71; 95% CI 0.52–0.96) compared with combined standard BP and glycemia treatment. For secondary outcomes, MI was significantly reduced by intensive glycemia treatment and stroke by intensive BP treatment; most other HRs were neutral or favored intensive treatment groups. In the lipid trial, the general pattern of results showed no evidence of benefit of intensive regimens (whether single or combined) compared with combined standard lipid and glycemia treatment. The mortality HR was 1.33 (95% CI 1.02–1.74) in the standard lipid/intensive glycemia group compared with the standard lipid/standard glycemia group. CONCLUSIONS In the ACCORD BP trial, compared with combined standard treatment, intensive BP or intensive glycemia treatment alone improved major CVD outcomes, without additional benefit from combining the two. In the ACCORD lipid trial, neither intensive lipid nor glycemia treatment produced an overall benefit, but intensive glycemia treatment increased mortality.

Original languageEnglish (US)
Pages (from-to)1721-1728
Number of pages8
JournalDiabetes care
Volume37
Issue number6
DOIs
StatePublished - Jan 1 2014

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Risk Management
Type 2 Diabetes Mellitus
Blood Pressure
Lipids
Therapeutics
Cardiovascular Diseases
Simvastatin
Stroke
Myocardial Infarction
Fenofibrate
Mortality
Proportional Hazards Models
Hemoglobins
Research Design
Placebos

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Margolis, K. L., O'Connor, P. J., Morgan, T. M., Buse, J. B., Cohen, R. M., Cushman, W., ... Goff, D. C. (2014). Outcomes of combined cardiovascular risk factor management strategies in type 2 diabetes: the accord randomized trial. Diabetes care, 37(6), 1721-1728. https://doi.org/10.2337/dc13-2334

Outcomes of combined cardiovascular risk factor management strategies in type 2 diabetes : the accord randomized trial. / Margolis, Karen L.; O'Connor, Patrick J.; Morgan, Timothy M.; Buse, John B.; Cohen, Robert M.; Cushman, William; Cutler, Jeffrey A.; Evans, Gregory W.; Gerstein, Hertzel C.; Grimm, Richard H.; Lipkin, Edward W.; Narayan, K. M.Venkat; Riddle, Matthew C.; Sood, Ajay; Goff, David C.

In: Diabetes care, Vol. 37, No. 6, 01.01.2014, p. 1721-1728.

Research output: Contribution to journalArticle

Margolis, KL, O'Connor, PJ, Morgan, TM, Buse, JB, Cohen, RM, Cushman, W, Cutler, JA, Evans, GW, Gerstein, HC, Grimm, RH, Lipkin, EW, Narayan, KMV, Riddle, MC, Sood, A & Goff, DC 2014, 'Outcomes of combined cardiovascular risk factor management strategies in type 2 diabetes: the accord randomized trial', Diabetes care, vol. 37, no. 6, pp. 1721-1728. https://doi.org/10.2337/dc13-2334
Margolis, Karen L. ; O'Connor, Patrick J. ; Morgan, Timothy M. ; Buse, John B. ; Cohen, Robert M. ; Cushman, William ; Cutler, Jeffrey A. ; Evans, Gregory W. ; Gerstein, Hertzel C. ; Grimm, Richard H. ; Lipkin, Edward W. ; Narayan, K. M.Venkat ; Riddle, Matthew C. ; Sood, Ajay ; Goff, David C. / Outcomes of combined cardiovascular risk factor management strategies in type 2 diabetes : the accord randomized trial. In: Diabetes care. 2014 ; Vol. 37, No. 6. pp. 1721-1728.
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abstract = "OBJECTIVE To compare effects of combinations of standard and intensive treatment of glycemia and either blood pressure (BP) or lipids in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. RESEARCH DESIGN AND METHODS ACCORD enrolled 10,251 type 2 diabetes patients aged 40–79 years at high risk for cardiovascular disease (CVD) events. Participants were randomly assigned to hemoglobin A1c goals of <6.0{\%} (<42 mmol/mol; intensive glycemia) or 7.0–7.9{\%} (53–63 mmol/mol; standard glycemia) and then randomized a second time to either 1) systolic BP goals of <120 mmHg (intensive BP) or <140 mmHg (standard BP) or 2) simvastatin plus fenofibrate (intensive lipid) or simvastatin plus placebo (standard lipid). Proportional hazards models were used to assess combinations of treatment assignments on the composite primary (deaths due to CVD, nonfatal myocardial infarction [MI], and nonfatal stroke) and secondary outcomes. RESULTS In the BP trial, risk of the primary outcome was lower in the groups intensively treated for glycemia (hazard ratio [HR] 0.67; 95{\%} CI 0.50–0.91), BP (HR 0.74; 95{\%} CI 0.55–1.00), or both (HR 0.71; 95{\%} CI 0.52–0.96) compared with combined standard BP and glycemia treatment. For secondary outcomes, MI was significantly reduced by intensive glycemia treatment and stroke by intensive BP treatment; most other HRs were neutral or favored intensive treatment groups. In the lipid trial, the general pattern of results showed no evidence of benefit of intensive regimens (whether single or combined) compared with combined standard lipid and glycemia treatment. The mortality HR was 1.33 (95{\%} CI 1.02–1.74) in the standard lipid/intensive glycemia group compared with the standard lipid/standard glycemia group. CONCLUSIONS In the ACCORD BP trial, compared with combined standard treatment, intensive BP or intensive glycemia treatment alone improved major CVD outcomes, without additional benefit from combining the two. In the ACCORD lipid trial, neither intensive lipid nor glycemia treatment produced an overall benefit, but intensive glycemia treatment increased mortality.",
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AU - O'Connor, Patrick J.

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AU - Buse, John B.

AU - Cohen, Robert M.

AU - Cushman, William

AU - Cutler, Jeffrey A.

AU - Evans, Gregory W.

AU - Gerstein, Hertzel C.

AU - Grimm, Richard H.

AU - Lipkin, Edward W.

AU - Narayan, K. M.Venkat

AU - Riddle, Matthew C.

AU - Sood, Ajay

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N2 - OBJECTIVE To compare effects of combinations of standard and intensive treatment of glycemia and either blood pressure (BP) or lipids in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. RESEARCH DESIGN AND METHODS ACCORD enrolled 10,251 type 2 diabetes patients aged 40–79 years at high risk for cardiovascular disease (CVD) events. Participants were randomly assigned to hemoglobin A1c goals of <6.0% (<42 mmol/mol; intensive glycemia) or 7.0–7.9% (53–63 mmol/mol; standard glycemia) and then randomized a second time to either 1) systolic BP goals of <120 mmHg (intensive BP) or <140 mmHg (standard BP) or 2) simvastatin plus fenofibrate (intensive lipid) or simvastatin plus placebo (standard lipid). Proportional hazards models were used to assess combinations of treatment assignments on the composite primary (deaths due to CVD, nonfatal myocardial infarction [MI], and nonfatal stroke) and secondary outcomes. RESULTS In the BP trial, risk of the primary outcome was lower in the groups intensively treated for glycemia (hazard ratio [HR] 0.67; 95% CI 0.50–0.91), BP (HR 0.74; 95% CI 0.55–1.00), or both (HR 0.71; 95% CI 0.52–0.96) compared with combined standard BP and glycemia treatment. For secondary outcomes, MI was significantly reduced by intensive glycemia treatment and stroke by intensive BP treatment; most other HRs were neutral or favored intensive treatment groups. In the lipid trial, the general pattern of results showed no evidence of benefit of intensive regimens (whether single or combined) compared with combined standard lipid and glycemia treatment. The mortality HR was 1.33 (95% CI 1.02–1.74) in the standard lipid/intensive glycemia group compared with the standard lipid/standard glycemia group. CONCLUSIONS In the ACCORD BP trial, compared with combined standard treatment, intensive BP or intensive glycemia treatment alone improved major CVD outcomes, without additional benefit from combining the two. In the ACCORD lipid trial, neither intensive lipid nor glycemia treatment produced an overall benefit, but intensive glycemia treatment increased mortality.

AB - OBJECTIVE To compare effects of combinations of standard and intensive treatment of glycemia and either blood pressure (BP) or lipids in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. RESEARCH DESIGN AND METHODS ACCORD enrolled 10,251 type 2 diabetes patients aged 40–79 years at high risk for cardiovascular disease (CVD) events. Participants were randomly assigned to hemoglobin A1c goals of <6.0% (<42 mmol/mol; intensive glycemia) or 7.0–7.9% (53–63 mmol/mol; standard glycemia) and then randomized a second time to either 1) systolic BP goals of <120 mmHg (intensive BP) or <140 mmHg (standard BP) or 2) simvastatin plus fenofibrate (intensive lipid) or simvastatin plus placebo (standard lipid). Proportional hazards models were used to assess combinations of treatment assignments on the composite primary (deaths due to CVD, nonfatal myocardial infarction [MI], and nonfatal stroke) and secondary outcomes. RESULTS In the BP trial, risk of the primary outcome was lower in the groups intensively treated for glycemia (hazard ratio [HR] 0.67; 95% CI 0.50–0.91), BP (HR 0.74; 95% CI 0.55–1.00), or both (HR 0.71; 95% CI 0.52–0.96) compared with combined standard BP and glycemia treatment. For secondary outcomes, MI was significantly reduced by intensive glycemia treatment and stroke by intensive BP treatment; most other HRs were neutral or favored intensive treatment groups. In the lipid trial, the general pattern of results showed no evidence of benefit of intensive regimens (whether single or combined) compared with combined standard lipid and glycemia treatment. The mortality HR was 1.33 (95% CI 1.02–1.74) in the standard lipid/intensive glycemia group compared with the standard lipid/standard glycemia group. CONCLUSIONS In the ACCORD BP trial, compared with combined standard treatment, intensive BP or intensive glycemia treatment alone improved major CVD outcomes, without additional benefit from combining the two. In the ACCORD lipid trial, neither intensive lipid nor glycemia treatment produced an overall benefit, but intensive glycemia treatment increased mortality.

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