(a) The ACCORD Study Group
(b) Gerstein HC, Riddle MC, Kendall DM, Cohen RM, Goland R, Feinglos MN, Kirk JK, Hamilton BP, Ismail-Beigi F, Feeney P
(c) Cushman WC, Grimm RH Jr, Cutler JA, Evans GW, Capes S, Corson MA, Sadler LS, Alderman MH, Peterson K, Bertoni A, Basile JN
(d) Ginsberg HN, Bonds DE, Lovato LC, Crouse JR, Elam MB, Linz PE, O’Connor PJ, Leiter LA, Weiss D, Lipkin E, Fleg JL
(e) Kingry C, Bastien A, Booth G, Geraci TS, Kirpach BR, Lovato LC, Margolis KL, Rosenberg Y, Sperl-Hillen JM, Vargo L, Williamsom JD, Probstfield JL
(f) Action to Control Cardiovascular Risk in Diabetes study group
(g) ACCORD Study Group
(h) ACCORD Study Group

(a) Action to Control Cardiovascular Risk in Diabetes (ACCORD). Trial: design and methods
(b) Glycemia treatment strategies in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial
(c) Rationale and design for the blood pressure intervention of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial
(d) Evolution of the lipid trial protocol of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial
(e) Recruitment strategies in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial
(f) Effects of intensive glucose lowering in type 2 diabetes
(g) Effects of combination lipid therapy in Type 2 diabetes mellitus
(h) Effects of intensive blood-pressure control in type 2 diabetes mellitus

(a) Am J Cardiol 2007;99 Suppl:21i–33i
(b) Am J Cardiol 2007;99 Suppl:34i–43i
(c) Am J Cardiol 2007;99 Suppl:44i–55i
(d) Am J Cardiol 2007;99 Suppl:56i–67i
(e) Am J Cardiol 2007;99 Suppl:68i–79i
(f) New Engl J Med 2008;358:2545–59
(g) N Engl J Med 2010;362:1563–74
(h) N Engl J Med 2010;362:1575–85

Diabetes mellitus, cardiovascular disease

To assess the efficacy of 3 treatment strategies (glycaemic control, lipid control and BP control) in reducing cardiovascular disease morbidity and mortality in patients with diabetes mellitus

Randomised, double 2 x 2 factorial

Mean 5.6 years

10,251 patients (all glycaemic control, 5518 lipid control, 4733 BP control), mean age 62.2 ± 6.8 years, with type 2 diabetes ≥ 3 months, at high risk of cardiovascular events

Glycaemic control: intensive glycaemic control, to target HbA_1c < 6%, or standard glycaemic control, to target HbA_1c 7.0–7.9%
Lipid control: simvastatin, titrated to 40 mg/day to target LDL cholesterol < 100 mg/dl, or simvastatin plus fenofibrate, 160 mg/day
BP control: intensive BP control, to target SBP < 120 mm Hg, or standard BP control, to target SBP < 140 mm Hg

The primary composite outcome of nonfatal MI, nonfatal stroke or death for cardiovascular causes occurred in 6.9% of patients in the intensive glycaemic control group and in 7.2% in the standard glycaemic control group (hazard ratio 0.90, 95% CI 0.78–1.04; p = 0.16). In the intensive glycaemic control group, the rate of nonfatal MI was lower (3.6% vs 4.6%, hazard ratio 0.76, 95% CI 0.62–0.92; p = 0.004) and the rate of death from cardiovascular causes was higher (2.6% vs 1.8%, hazard ratio 1.35, 95% CI 1.04–1.76; p = 0.02) compared to the standard glycaemic control group. There was no significant difference in the rate of nonfatal stroke (p = 0.74). In the lipid control arm (ACCORD Lipid), the annual rate of the primary outcome of first occurrence of a major cardiovascular event was 2.4% in the simvastatin-alone group and 2.2% in the simvastatin plus fenofibrate group (hazard ratio in the simvastatin plus fenofibrate group 0.92, 95% CI 0.79–1.08; p = 0.32). In the BP control arm (ACCORD BP), the annual rate of the primary outcome of first occurrence of a major cardiovascular event was1.87% in the intensive BP control group and 2.09% in the standard BP control group (hazard ratio in the intensive BP control group 0.88, 95% CI 0.73–1.06; p = 0.20)

The data and safety monitoring committee recommended the discontinuation of the intensive glycaemic control regimen after a mean follow-up of 3.5 years, because of the finding of higher mortality in this group