The ACCORD (Action to Control Cardiovascular Risk in Diabetes) Lipid Trial

Abstract

Atherosclerotic cardiovascular disease is increased severalfold in most patients with type 2 diabetes, particularly patients who are older and have other risk factors (1,2). These associated risk factors include hypertension, obesity, and dyslipidemia. Diabetic dyslipidemia, which has also been called atherogenic dyslipidemia (a term that describes the lipid abnormalities in people with insulin resistance, metabolic syndrome, and type 2 diabetes), is characterized by elevated plasma triglyceride (TG) levels, low levels of HDL cholesterol, and smaller cholesterol ester–depleted LDL (3). Despite the fact that statins, which mainly lower blood levels of LDL cholesterol, have the same relative effectiveness in type 2 diabetic patients as in nondiabetic subjects, absolute rates of atherosclerotic cardiovascular disease events remained higher in patients with diabetes who participated in all of the statin trials (4,5). These findings have raised interest in the use of combination therapy, particularly the combination of a statin plus a drug that would lower plasma TG levels and raise plasma HDL cholesterol levels. ACCORD (Action to Control Cardiovascular Risk in Diabetes) was specifically designed to determine the effects of intensive treatment of blood glucose, and either blood pressure (ACCORD Blood Pressure) or plasma lipids (ACCORD Lipid), on atherosclerotic cardiovascular disease outcomes in patients with type 2 diabetes who were at high risk of such an outcome (6). The ACCORD Lipid trial tested the hypothesis that treatment of patients with type 2 diabetes with fenofibrate to increase plasma HDL cholesterol levels and reduce plasma TG concentrations, on the …