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Rev Med Suisse. 2010 Sep 1;6(260):1582-7.

[Multirisk approach of the type 2 diabetic patient: controversies surrounding target values after the ACCORD trial].

[Article in French]

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Service de diabétologie, nutrition et maladies métaboliques et Unité de pharmacologie clinique, Département de médecine, CHU Sart Tilman, 4000 Liege, Belgique.


The ACCORD trial investigated the effects of intensifying the global management of 10,251 type 2 diabetic patients, with established cardiovascular disease or at least two other cardiovascular risk factors, on a composite endpoint (non fatal myocardial infarction, stroke and cardiovascular death). The attempt to reduce HbA1c level below 6% was associated with an increased cardiovascular mortality (despite a reduction in non fatal myocardial infarcts); lowering systolic blood pressure below 120 mmHg instead of 140 mmHg did not provide any additional benefit; finally, the control of atherogenic dyslipidaemia, with fenofibrate added to a statin, did not modify the composite endpoint (despite a positive effect in the subgroup of patients with high triglycerides and low HDL cholesterol). These rather disappointing results should be interpreted to provide practical guidelines.

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