The accord study data and biospecimens are now available in the nhlbi biological specimen and data repository information coordinating center biolincc overview of accord and accordion. The action to control cardiovascular risk in diabetes study group members of the action to control cardiovascular risk in diabetes accord study group are listed in the appendix. The accordlipid trial tested the efficacy of combined statinfibrate treatment on cardiovascular disease events in patients with type 2 diabetes mellitus at a high risk of cardiovascular disease in the action to control cardiovascular risk in diabetes accord lipid trial, 5518 patients with t2dm were randomly assigned to receive fenofibrate or placebo on a background of statin simvastatin therapy. In the accord study, participants had type 2 diabetes on average for 10 years at the time of enrollment, had higher a1c levels than most type 2 diabetic patients in the u. Accord, advance, and the vadt were three large clinical trials that compared the rates of heart disease in patients receiving either intensive diabetes treatment targeting nearnormal average blood glucose levels a1c closer to 6%, or conventional diabetes treatment targeting somewhat higher blood glucose. Accord protocol january 05, 2009 version 2 the accord study is designed to have. The results of the accord glycemia and blood pressure trials were published separately 5,6. The accord trial was conducted at 77 clinical sites in the usa and canada between the years 2001 and 2009. Listing a study does not mean it has been evaluated by the u.
Effects of medical therapies on retinopathy progression in type 2 diabetes. The action to control cardiovascular risk in diabetes study group epidemiologic studies have shown a relationship between glycated hemoglobin levels and cardiovascular events in patients with. Jun 06, 2008 in patients with diabetes, high glycated hemoglobin hba 1c levels are associated with elevated risks for cardiovascular events and death. Relationship of obesity to adverse events among patients with. Rationale, design and methods of the action to control cardiovascular risk in diabetes accord trial supported by the national heart, lung, and blood institute nhlbi, the national institute of diabetes, and digestive and kidney diseases niddk, the national eye institute nei, the national institute on aging nia, and the centers for disease control and prevention cdc general clinical. This randomized control trial rct sets out to test if there is a correlation between a1c and cardiovascular cv events. The action to control cardiovascular risk in diabetes study. We assessed 10 251 adults aged 4079 years with established type 2 diabetes, mean glycated haemoglobin a 1c hba 1c concentration of 67 mmolmol 83%, and risk factors for ischaemic heart disease enrolled in the accord trial.
Third, the same benefit of glycemic control in reducing. Effects of intensive glucose lowering in type 2 diabetes. In 2008, the results of the glucose control study raised some eyebrows. Accord eye study in addition, there was another substudy of the accord trial called the accord eye study, which took a small subgroup of patients and looked at factors that contributed toward progression of diabetic retinopathy. People with diabetes, high hba 1c concentrations 75%, and cardiovascular disease or. Accord diabetes trial1 intensive versus standard a1c targets in t2dm mortality with a very intensive glucose lowering strategy in high cv risk t2dm patients research question.
Diabetic dyslipidemia, which has also been called atherogenic dyslipidemia a term that describes the lipid abnormalities in people with. Accord was a parallelgroup, randomised trial done in 77 clinical sites in north america. Participants were assigned to intensive or standard therapy target hba 1c less than 42 or 5363 mmolmol less than 60% or 7079%, respectively. Protocol accord action to control cardiovascular risk. Using baseline bp or lipids, participants were randomly assigned to either intensive or standard bp or lipid treatment and then underwent a second randomization to either standard or intensive glycemic control. The dais diabetes atherosclerosis intervention study investigators data a very successful angiographic. The action to control cardiovascular disease in diabetes accord blood pressure trial is an unmasked, openlabel. A large clinical study designed to determine whether intensively lowering blood glucose levels, intensively lowering blood pressure, or treating blood lipid levels could reduce the risk of heart attack, stroke, or death in people with type 2 diabetes. The action to control cardiovascular risk in diabetes accord trial clinicaltrials. Accord was a randomized trial conducted at 77 clinical sites. In accordlipid, 5518 patients with t2dm were randomly assigned to receive fenofibrate or placebo on a background of treatment with. Prior to the accord trial, several randomized controlled trials had been conducted regarding blood sugar control in.
Effects of intensive glucose lowering in type 2 diabetes nejm. The accord study investigated whether intensive therapy to target normal glycated hemoglobin hba1c levels would reduce cardiovascular events in patients with type 2 diabetes who had either established cardiovascular disease or additional cardiovascular risk factors when compared to standard therapy hba1c between 7. Nejm 2010 on face value the trial seems to be null on the ability of fenofibrate to improve outcomes in t2dm patients. The accord study was a large clinical study designed to determine whether various interventions could reduce heart risk in people with type 2 diabetes. Jun 27, 2019 accordion the accord followup study is a prospective, observational followup study of at least 8000 participants who were treated and followed in the action to control cardiovascular risk in diabetes accord trial. The study of more than 10,000 participants is sponsored by the national institutes of health. The accord action to control cardiovascular risk in diabetes. The accord action to control cardiovascular risk in. It has over 10,000 participants between the ages of 40 and 82 who have been involved with the study for between two and seven years.
Protocol accord action to control cardiovascular risk in. Accord is one of the largest studies ever conducted in adults with type 2 diabetes who were at especially high risk of cardiovascular events, such as heart attacks, stroke, or death from cardiovascular disease. These associated risk factors include hypertension, obesity, and dyslipidemia. Pdf accord and riskfactor control in type 2 diabetes. The action to control cardiovascular risk in diabetes study group. First, sulfonylureas are as safe as insulin in controlling blood glucose. Nov 26, 2017 a large clinical study designed to determine whether intensively lowering blood glucose levels, intensively lowering blood pressure, or treating blood lipid levels could reduce the risk of heart attack, stroke, or death in people with type 2 diabetes. We do have previous data with fibrates in diabetics or tghdl axis disorders. Gaude p, vedel p, larsen n, jensen gvh, parving h, pedersen o. Amid much media interest, preliminary data of the accord action to control cardiovascular risk in diabetes study were released in view of the unexpected finding that type 2 diabetic t2dm patients in the intensive blood glucoselowering treatment arm target glycated haemoglobin hba1c diabetes accord is all about.
Accord study group and accord eye study group, effects of medical therapies on retinopathy progression in type 2 diabetes. Most patients with type 2 diabetes mellitus develop cardiovascular disease cvd, with substantial. We present here the main results of the accord bp trial. We used data from the accord the action to control cardiovascular risk in diabetes study to evaluate the relationship between obesity and adverse events in patients with a mean 10. Accord diabetes trial intensive versus standard a1c targets. Jun 18, 2007 the action to control cardiovascular risk in diabetes accord trial is a randomized, multicenter, double 2 x 2 factorial design study involving 10,251 middleaged and older participants with type 2 diabetes who are at high risk for cvd events because of existing cvd or additional risk factors. Hypertension is a common co morbidity in patients with type 2 diabetes. Accordbp blood pressure investigated whether reducing systolic blood pressure to 75%, and cardiovascular disease or. It is therefore now appropriate to take stock and consider the clinical implications of these results. Clinical implications of the accord trial the journal of. And in this trial there was a positive result with a 33% reduction in progression of retinopathy in patients who were. They also experience increased rates of nonfatal myocardial infarction and stroke. The rationale and design of the action to control cardiovascular risk in diabetes accord trial and its healthrelated quality of life substudy have been reported previously.
Aug, 20 the accord study investigated whether intensive therapy to target normal glycated hemoglobin hba1c levels would reduce cardiovascular events in patients with type 2 diabetes who had either established cardiovascular disease or additional cardiovascular risk factors when compared to standard therapy hba1c between 7. Association between seven years of intensive treatment of type 1 diabetes and longterm mortality. In the case of fenofibrate, 2 cardiovascular end point trials conducted within the last decade failed to show benefit with administration of fenofibrate in patients with type 2 diabetes either alone in the field study 24 or as addon therapy to statin in the accord study. Some, but not all, studies have shown that lowering hba 1c levels reduces cardiovascular risk, and these data have been used to support current guidelines that recommend a target hba 1c level of. Treatment in accord ended in 2009 and accordion is designed to further elucidate and clarify the long. Accord diabetes trial intensive versus standard a1c targets in. Effects of intensive glycaemic control on ischaemic heart. The new england journal of medicine n engl j med 362.
The action to control cardiovascular risk in diabetes accord trial was specifically designed to determine whether a therapeutic strategy targeting normal glycated hemoglobin levels i. Dec 18, 2014 the study, known as the action to control cardiovascular risk in diabetes accord trial, is being conducted at 77 sites in north america. Landmark accord trial finds intensive blood pressure and. The accordlipid results were published in the spring of 2010. Effects of intensive bloodpressure control in type 2. 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. Comment the accord trial was inspired by previous research that found a link between tightly controlled blood sugar and reduced risk for many complications of type 2 diabetes. The accord randomized trial diabetes care american. The action to control cardiovascular disease in diabetes accord study has completed its full 5yr planned followup, and all main results have been published 14. Lack of association between thiazolidinediones and macular.
Action to control cardiovascular risk in diabetes accord. Effects of intensive bloodpressure control in type 2 diabetes mellitus. Second, metformin reduced cardiovascular disease in an overweight subgroup. Accord action to control cardiovascular risk in diabetes. Action to control cardiovascular risk in diabetes accord accord the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Accord was a randomized trial conducted at 77 clinical sites organized into seven networks in the united states and canada.
A comparison of the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment on risk factors for. The american journal of cardiology rationale, design and. The action to control cardiovascular risk in diabetes accord trial sought to explore whether more intensive glucose control regimens were associated with better outcomes in patients with type 2 diabetes mellitus. Neuropathy and related findings in the diabetes control and complications trialepidemiology of diabetes interventions and complications study. Diabetes can also result in microvascular complications such as retinopathy, neuropathy, and nephropathy, which are the leading causes of blindness, nontraumatic foot amputation, and endstage renal disease, respectively. Action to control cardiovascular risk in diabetes accord trial. All participants in the accord study have type 2 diabetes and either coronary heart disease or at least two risk factors for adverse cardiovascular events. Accord study group, rationale, design, and methods of the action to control cardiovascular risk in diabetes eye study accord trial. Prospective diabetes study ukpds in 1998 helped to shape the management of type 2 diabetes in recent years 1. Accord diabetes trial intensive versus standard a1c.
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