Blood Pressure; Cardiovascular Diseases/prevention & control; Clinical Trials as Topic; Diabetes Mellitus, Type 2/blood/drug therapy; Hemoglobin A, Glycosylated/analysis; Humans; Hypoglycemic Agents/therapeutic use; Lipids/blood
Abstract :
[en] The ACCORD trial investigated the effects of intensifying the global management of 10,251 type 2 diabetic patients, with established cardiovascular disease or at least two other cardiovascular risk factors, on a composite endpoint (non fatal myocardial infarction, stroke and cardiovascular death). The attempt to reduce HbA1c level below 6% was associated with an increased cardiovascular mortality (despite a reduction in non fatal myocardial infarcts); lowering systolic blood pressure below 120 mmHg instead of 140 mmHg did not provide any additional benefit; finally, the control of atherogenic dyslipidaemia, with fenofibrate added to a statin, did not modify the composite endpoint (despite a positive effect in the subgroup of patients with high triglycerides and low HDL cholesterol). These rather disappointing results should be interpreted to provide practical guidelines. [fr] L’étude ACCORD a évalué les effets d’une intensification de la prise en charge de 10.251
patients diabétiques de type 2, avec une maladie cardiovasculaire établie ou au moins deux autres
facteurs de risque, sur un critère composite (infarctus non mortels, accidents vasculaires
cérébraux non mortels et décès d’origine cardiovasculaire). L’intensification du traitement
hypoglycémiant (visant une HbA1c < 6 %), du traitement antihypertenseur (visant une pression
systolique < 120 mm Hg) et/ou du traitement hypolipidémiant (ajout de fénofibrate à une statine)
n’a pas modifié significativement le critère primaire. Un excès de mortalité cardiovasculaire
(malgré moins d’infarctus non mortels) a fait interrompre prématurément le bras intensif
glycémie. Ces résultats décevants doivent être interprétés pour formuler des recommandations
pratiques.
Scheen, André ; Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Paquot, Nicolas ; Centre Hospitalier Universitaire de Liège - CHU > Diabétologie,nutrition, maladies métaboliques
Language :
French
Title :
Approche multirisque du patient diabetique de type 2: desaccord sur les valeurs cibles suite a l'etude ACCORD.
Alternative titles :
[en] Multirisk approach of the type 2 diabetic patient: controversies surrounding target values after the ACCORD trial
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