Aggressive Heart Management in Diabetes

04/08/08 Prevention

The National Institute of Health recommends that patients with diabetes maintain systolic blood pressure (SBP) below 131 mm Hg. Physicians generally recommend patients maintain their LDL cholesterol (LDL-C) at 101 mg/dL or less. This study evaluated the value of improving blood pressure and LDL cholesterol even further.

Patients in the aggressive group who maintained SBP at 115 mm Hg or lower, as well as LDL-C at 75 mg/dL or less were able to markedly reduce the amount of plaque build-up in their carotid arteries—the arteries that deliver blood from the heart through the neck. The mass of the left ventricle also decreased in these patients, indicating that their hearts were not having to work as hard.

"The aggressive group actually had a reduction in the thickness of the neck vessels, an actual reduction in what we see as an indicator of plaque buildup, and that has not been seen in most studies," said lead author Barbara Howard, Ph.D.

Howard and her fellow researchers at the MedStar Research Institute in Maryland conducted the study in 499 American Indian men and women with type 2 diabetes. Each volunteer was randomly assigned to one of the following groups:

• Aggressive targets of LDL-C of 70 mg/dL or lower plus SBP of 115 mm Hg or lower.
• Standard targets of LDL-C of 100 mg/dL or lower and SBP of 130 mm Hg or lower.

American Indians have a high prevalence of diabetes and diabetes-related cardiovascular disease. The three-year trial was conducted at four clinical centers in Oklahoma, Arizona, and South Dakota.
 
Average target LDL-C and SBP levels for both groups were reached using medical care including diabetes management, diet management, exercise, and smoking cessation counseling.

At the end of the study researchers observed no difference in heart attacks between the two groups. However, there were noticeable differences in the heart health of the patients who reached the aggressive targets.

One major problem with this study is that it only followed patients for three years. It was not enough time to measure the long-term effects of aggressive blood pressure and cholesterol treatment. Many doctors and scientists speculate that the aggressive group would've experienced a much lower heart attack rate if the length of the study had been extended.

Source:

JAMA, April 2008