February 3rd, 2014
Intensive BP, Lipid Lowering Does Not Protect Against Cognitive Decline in Diabetics
Intensive treatment of blood pressure or cholesterol does not slow the rate of cognitive decline in adults with type 2 diabetes, according to a substudy of the ACCORD trial published in JAMA Internal Medicine.
Some 3000 older adults with poorly controlled diabetes, high cardiovascular risk, and no evidence of cognitive impairment were assigned to one of two study arms: in one, participants were randomized to either intensive BP lowering (systolic goal, <120 mm Hg) or standard BP therapy (goal, <140 mm Hg); in the other, participants with LDL levels controlled below 100 mg/dL on simvastatin were randomized to either additional therapy with fenofibrate or placebo.
At 40 months, cognitive scores had decreased in all groups, with no difference between intensive and standard BP treatment nor between fibrate and placebo.
The researchers conclude that these results, along with previous ACCORD findings, “make clear the decreasing returns of intensive medication-based therapy” for advanced type 2 diabetes.