The ACCORD trials were designed to test strategies for CVD reduction among diabetic patients. The therapeutic strategy targeting a low (<120 mmHg) systolic blood pressure (SBP) reduced CVD events compared to the standard (<140 mmHg) SBP target in patients with type 2 diabetes at high risk for CVD events.

• ACCORD BP trial – The ACCORD BP Trial results provided inconclusive evidence that BP lowering to normal SBP levels (<120 mmHg) rather than to the standard SBP goal (<140 mmHg) reduces a combination of major CVD events in high-risk patients with type-2 diabetes. There was a higher risk of severe adverse events in the intensive BP lowering group, but a lower stroke rate (41%). The stroke effect is consistent with other BP treatment trials. Nonetheless, an SBP goal <120 mmHg may reduce strokes in patients with diabetes.

• ACCORD lipid trial – The ACCORD Lipid trial did not provide evidence supporting the use of the combination of fenofibrate and simvastatin in reducing CVD events in the majority of patients with type-2 diabetes mellitus who have HDL-C and TG levels within the normal range. The rate of major fatal or non-fatal CVD events with the combination therapy was 2.24% compared with 2.41% with placebo (p=0.32). Data from subgroup analyses (by gender and by the presence of significant dyslipidemia) suggesting heterogeneity in response to combination therapy require further investigation.

Echoing one of the key messages of WCC 2010 in his presentation, Dr Sidney Smith observed that, “Whereas the causes of CVD are common in all parts of the world, the approaches to its prevention at a societal or individual level will differ between countries for cultural, social, medical, and economic reasons.” Notably, no Asian centers and patients were reported in the ACCORD trial. In terms of blood pressure, a prespecified secondary endpoint of reduced stroke may be important for Asian patients. Future lipid studies should consider subgroups of women and those with triglyceride levels >200 mg/dL or HDL-C <35 mg/dL.