ACCORD 的研究證實 type 2 DM不用控制血壓太嚴，fenofibrate沒用

Intensive Blood Pressure Control, Fenofibrate Lipid Therapy Not Justified in High-Risk Diabetics

Two studies from the ACCORD research group indicate that neither strict blood pressure control nor the addition of fenofibrate to statin therapy is justified in type 2 diabetes. The studies were presented Sunday at the American College of Cardiology conference.

In the ACCORD blood pressure study, investigators randomized some 4700 high-risk patients with type 2 diabetes to one of two systolic blood pressure goals: below 120 mm Hg (intensive control) or under 140 mm Hg (standard). Over an average 5-year follow-up, the annual rate of nonfatal MI, nonfatal stroke, or cardiovascular death did not differ between the groups, although complications from antihypertensive therapy were higher with intensive control.

Separately, in the ACCORD lipid study, 5500 high-risk diabetics already taking simvastatin were randomized to add-on fenofibrate or placebo. As in the blood pressure study, annual rates of cardiovascular events did not differ between groups.

Writing in Journal Watch Cardiology, Dr. Harlan Krumholz says intensive blood pressure control, "should not be used" in high-risk diabetics. Commenting on the lipid study he says that "the burden of proof is firmly on advocates of [fenofibrate] to justify the cost and risk."
LINK(S):

NEJM report on the ACCORD blood pressure study (Free abstract; full text requires subscription)

NEJM report on the ACCORD lipid study (Free abstract; full text requires subscription)

NEJM editorial (Subscription required)

Journal Watch Cardiology summary on intensive blood pressure control (Free)

Journal Watch Cardiology summary on lipid therapy (Free)

Published in Physician's First Watch March 15, 2010

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https://docs.google.com/fileview?id=0B278nGJMQBk7NTA4MDFmMGYtOWNiZS00ZGE4LWFjZGEtMjJiYmZhMTQ3Yzg1&hl=zh_TW

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