ACCORD

Action to Control
Cardiovascular Risk in
Diabetes Trial

CHOO KOK YEW MBBS

B14

Reference:
1) https://www.accordtrial.org/public/index.cfm?
CFID=8424&CFTOKEN=36546ad28e6d73e6-F9FD1B66-EE95-EC9207B46739F12E8704
2) http://www.nhlbi.nih.gov/health/prof/heart/other/accord/q_a.htm

What is ACCORD study?

The ACCORD (Action to Control
Cardiovascular Risk in Diabetes) study
was a large clinical trial of adults
with established type 2 diabetes
who are at especially high risk of
cardiovascular disease (CVD).
The ACCORD study was primarily
composed of three clinical trials: blood
sugar, blood pressure and lipid.

 The study began enrolling

participants in 2001 and took place
in 77 clinical sites across the United
States and Canada.
A total of 10,251 adults with
established type 2 diabetes
participated in ACCORD.

What questions did the

ACCORD study seek to
answer?
to determine if a strategy of
intensive lowering of blood sugar
levels, intensive lowering of blood
pressure, or treatment of blood lipids
with a fibrate drug plus a statin drug,
can reduce the risk of major CVD
events in patients with type 2
diabetes who are at especially high
risk of CVD.

However,
no previous clinical trial had tested
the effects of lowering blood sugar
or blood pressure to near-normal
levels in patients with type 2
diabetes, and no previous clinical
trial had tested the effects of
treating multiple blood lipids
compared to treating only LDLcholesterol in people with diabetes.

What is the status of the

ACCORD study?
All three ACCORD clinical trials have
ended. The National Heart, Lung, and
Blood Institute (NHLBI) stopped the
intensive blood sugar lowering
strategy on February 6, 2008, due to
safety concerns.
The blood pressure and lipid treatment
trials continued until the planned end
of the study in June 2009.

1) ACCORD Blood Sugar

Clinical Trial
ACCORD Data and Safety Monitoring
Board (DSMB) noticed that there is a
statistically significant 22% higher
rate of death in the intensive(HbA1C
< 6.4%) than the standard
group(HbA1C<7.5%).

ACCORD Blood Pressure

Clinical Trial
In the intensive group, an average systolic
blood pressure of less than 120 mm Hg
In the standard group, systolic blood
pressure averaged around 134 mm Hg
consistent with the goal of less than 140
mm Hg.
Result : on average, the standard
treatment for blood pressure lowering
treatment was just as good as the
intensive lowering treatment for
cardiovascular outcomes.

ACCORD Lipid Clinical

Trial
People with type 2 diabetes very
often have a combination of high
blood levels of LDL cholesterol, low
HDL cholesterol, and high
triglycerides.
LDL cholesterol is a major risk factor
for CVD in general and in patients
with type 2 diabetes in particular.

 statins lowers the rates of heart

attacks and cardiovascular death
fibrate medications are used to
increase the blood levels of the
good HDL cholesterol as well as
reduce triglycerides

Results
Overall, the fibrate and the placebo
groups did not differ in the rates of
the combined outcome of heart
attacks, strokes, or cardiovascular
death.

ADVANCE
Action in Diabetes and
Vascular Disease

Reference:
http://www.advance-trial.com
http://www.medicalnewstoday.com/releases/9
9074.php

ADVANCE
ADVANCE is the largest clinical trial
on diabetes ever conducted over
11,000 patients
These patients have come from 20
different countries.

Glucose lowering arm

results
intensive blood glucose control using
Diamicron MR (gliclazide modified release)
and other drugs as required, protects
patients against serious complications of
the disease.
Reduces the overall risk of serious
diabetes complications by 10%, with a
21% reduction in kidney disease and 30%
reduction in the development of
macroalbuminuria(a well established
marker of increased cardiovascular risk)

Blood pressure lowering

arm results
Preterax(perindopril and indapamide)
significantly reduces total
mortality by 14% and the risk of
cardiovacular death by 18%.
In absolute terms, one death would
be avoided for every 79 patients
treated with Preterax for five years.

Thank you