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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
Open accessAbstract
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.
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“As hyperglycaemia is linearly associated with increased cardiovascular disease risk 143, 144”
From Type 2 diabetes mellitus and psychological stress — a modifiable risk factor (2017) · cites this paper as [144]
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“When the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study was initiated, however, the available evidence did not clearly support the hypothesis that aggressive lowering of blood glucose concentration in patients with type 2 diabetes would result in cardiovascular benefit.5”
From The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: Retrospective epidemiological analysis of the ACCORD study (2010) · cites this paper as [5]
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Johnston, L. C., Piotie, P. N., Maposa, I., Singh, S., Kuonza, L. R., & de Voux, A. (2024) · African Journal of Primary Health Care & Family Medicine · doi:10.4102/phcfm.v16i1.4336 · Cited by 1
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Frequency of albuminuria in diabetic patients presenting with macrovascular complications.
Sohail, M., Fatima, F., Fatima, S., Khan, S. A., Anwar, S. A., Alam, M. A., & Abbasi, M. A. (2014) · PubMed · Cited by 1
Nutritional Interventions to Lower Cholesterol and Risk for Heart Disease in Children
Daniels, S. R., Hildebrandt, J., Brennan, L. K., & Couch, S. C. (2016) · Springer eBooks · doi:10.1007/978-3-319-43027-0_12 · Cited by 1
Cohen, C. M., Banon, T., Shalev, V., & Chodick, G. (2020) · Endocrinology Diabetes & Metabolism · doi:10.1002/edm2.124 · Cited by 1
Sachdewani, R. K., Dingra, L. C., & Memon, A. H. (2018) · The Professional Medical Journal · doi:10.29309/tpmj/18.4520 · Cited by 1
Modification of Cardiometabolic Risk Through Cannabinoid Type-1 Receptor Antagonism
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“These results may also reflect the pitfall of using inappropriate surrogate endpoints for treatment evaluation, as was the case with torcetrapib in ILLUMINATE,36 ezetimibe in ENHANCE,37 and intensive glucose level control in ACCORD.38 Furthermore, the negative primary endpoint might also be attributed to the short dur…”
ResultHackett, R. A. (2016) · UCL Discovery (University College London) · Cited by 1
Opportunities for preventing diabetes and its cardiovascular complications
van den Bos, G. A. M. (2007) · Cited by 1
Iannantuoni, F., Canet, F., Marañón, A., López‐Domènech, S., Vezza, T., Navarro, B., Solá, E., Morillas, C., Rocha, M., & Víctor, V. M. (2020) · doi:10.21203/rs.3.rs-40816/v1 · Cited by 1
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The Role of Combination Therapy for Hypertension After ACCOMPLISH
Lackland, D. T. (2010) · Current Cardiovascular Risk Reports · doi:10.1007/s12170-010-0101-0
“Further complicating high blood pressure management and control are the results from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, which was designed to test the effect of a target systolic blood pressure below 120 mm Hg on cardiovascular events among high-risk individuals with type 2 diabetes…”
BackgroundTaketa, K., Matsumura, T., Furukawa, N., & Araki, E. (2012) · Clinical Medicine Reviews in Vascular Health · doi:10.4137/cmrvh.s7434
Cho, E.-H., Lee, D. G., & Kim, S. (2010) · The Korean Journal of Internal Medicine
Dyslipidemia and type 2 diabetes: Implementing best current management
Chemitiganti, R. R. V., Chemitiganti, V., & Spellman, C. (2009)
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Metadata
- Authors
- Goff, D. C., Gerstein, H. C., Ginsberg, H. N., Cushman, W. C., Margolis, K. L., Byington, R. P., Buse, J. B., Genuth, S., Probstfield, J. L., & Simons-Morton, D. G.
- Affiliations
- Wake Forest University Health Sciences (US)
- Population Health Research Institute (CA)
- Columbia University (US)
- Memphis VA Medical Center (US)
- Hennepin County Medical Center (US)
- University of North Carolina at Chapel Hill (US)
- Case Western Reserve University (US)
- University of Washington Medical Center (US)
- Corresponding author
- Goff, David C.
- ORCID
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2007-06
- Volume
- 99
- Issue
- 12
- Pages
- S4-S20
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2086199335
- Cited by
- 229
- References
- 136
- Citations by year
- 2025: 8 · 2024: 8 · 2023: 4 · 2022: 6 · 2021: 6 · 2020: 14 · 2019: 11 · 2018: 13 · 2017: 18 · 2016: 14 · 2015: 14 · 2014: 13 · 2013: 10 · 2012: 9
- FWCI
- 14.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc95183-23-0-0, n01hc95180-24-0-1, n01hc95184-24-0-1, n01hc95181-23-0-1, n01hc95182-23-0-1, n01hc95178-28-0-1, n01hc95179-25-0-0)
- Centers for Disease Control and Prevention
- National Institute on Aging
- National Heart, Lung, and Blood Institute (N01- HC-95181, N01-HC- 95180, N01-HC-95178, Y1-HC-9035, N01-HC-95184, N01HC95179, IAA #Y1-HC-9035, Y1-HC-1010, N01‐HC‐95183, N01-HC-95182)
- National Eye Institute
- National Institute of Diabetes and Digestive and Kidney Diseases
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- type 2 diabetes, cardiovascular disease prevention, cardiovascular risk, glycemic control, HbA1c, LDL cholesterol lowering, triglycerides, HDL cholesterol, blood pressure control, dyslipidemia, ACCORD trial, cardiovascular events
- MeSH terms
- Antihypertensive Agents, Hypolipidemic Agents, Coronary Disease, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Humans, Fenofibrate, Randomized Controlled Trials as Topic, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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