Cited by 229Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Treatment and ManagementBlood Pressure and Hypertension Studies

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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

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Goff, David C., Gerstein, Hertzel C., Ginsberg, Henry N., Cushman, William C., Margolis, Karen L., Byington, Robert P., Buse, John B., Genuth, Saul, Probstfield, Jeffrey L., Simons-Morton, Denise G.·2007·The American Journal of Cardiology

DOI 10.1016/j.amjcard.2007.03.002

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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.

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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.”
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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: Goff, David C.
Gerstein, Hertzel C.
Ginsberg, Henry N.
Cushman, William C.
Margolis, Karen L.
Buse, John B.
Probstfield, Jeffrey L.
Venue: The American Journal of Cardiology
Publisher: Elsevier BV
Published: 2007-06
Volume: 99
Issue: 12
Pages: S4-S20
ISSN: 0002-9149 (ISSN-L)
DOI: 10.1016/j.amjcard.2007.03.002
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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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

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