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

David C. Goff, Hertzel C. Gerstein, Henry N. Ginsberg, William Cushman, Karen L. Margolis, Robert P. Byington, John B. Buse, Saul Genuth, Jeffrey L. Probstfield, Denise G. Simons-Morton

Research output: Contribution to journalArticle

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Abstract

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 <140 mm Hg results in 30%-60% reductions in CVD events; however, epidemiologic evidence suggests that lowering to optimal systolic blood pressure levels (<120 mm Hg) may be additionally beneficial. Important questions regarding prevention of CVD in patients with diabetes remain unresolved, including the benefits of near-normal glycemic control, comprehensive therapy for diabetes-related dyslipidemia, and optimal blood pressure control. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial will test hypotheses to address these unanswered questions.

Original languageEnglish (US)
JournalAmerican Journal of Cardiology
Volume99
Issue number12 SUPPL.
DOIs
StatePublished - Jun 18 2007

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Type 2 Diabetes Mellitus
Cardiovascular Diseases
Blood Pressure
Knowledge Bases
Glycosylated Hemoglobin A
Dyslipidemias
LDL Cholesterol
HDL Cholesterol
Triglycerides
Public Health
Demography
Clinical Trials
Lipids
Glucose

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

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. / Goff, David C.; Gerstein, Hertzel C.; Ginsberg, Henry N.; Cushman, William; Margolis, Karen L.; Byington, Robert P.; Buse, John B.; Genuth, Saul; Probstfield, Jeffrey L.; Simons-Morton, Denise G.

In: American Journal of Cardiology, Vol. 99, No. 12 SUPPL., 18.06.2007.

Research output: Contribution to journalArticle

Goff, David C. ; Gerstein, Hertzel C. ; Ginsberg, Henry N. ; Cushman, William ; Margolis, Karen L. ; Byington, Robert P. ; Buse, John B. ; Genuth, Saul ; Probstfield, Jeffrey L. ; Simons-Morton, Denise G. / 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. In: American Journal of Cardiology. 2007 ; Vol. 99, No. 12 SUPPL.
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