Implications of the ACCORD Lipid study: perspective from the Residual Risk Reduction Initiative (R³i)

Abstract

Most type 2 diabetes patients remain at high residual risk of cardiovascular events despite best treatment. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial aimed to address this challenge, by evaluating whether intensive control of glycaemia and high blood pressure, or as in ACCORD Lipid, extending lipid treatment with the combination of fenofibrate plus simvastatin, could impact this risk. ACCORD Lipid showed that treatment beyond low-density lipoprotein cholesterol was not appropriate for most type 2 diabetes patients. However, a subgroup analysis did suggest additional benefit in patients with atherogenic dyslipidaemia, the combination of high baseline triglycerides (≥204 mg/dL or 2.3 mmol/L) and low baseline plasma levels of high-density lipoprotein cholesterol (≤34 mg/dL or 0.88 mmol/L). This finding is concordant with subgroup analyses from other fibrate trials in patients with high triglycerides and low plasma levels of high-density lipoprotein cholesterol, and consistent with current guideline recommendations. This commentary from the Residual Risk Reduction Initiative (R³i), discusses the ACCORD Lipid study results and the next steps to establish the clinical relevance of these findings.

Key words:

• ACCORD trial
• Dyslipidaemia
• High-density lipoprotein cholesterol
• Residual cardiovascular risk
• Triglycerides
• Type 2 diabetes

Transparency

Declaration of funding

The Residual Risk Reduction Initiative (R3i) is an independent academic non-profit educational and research Foundation, registered in Switzerland. The mission of the R3i is to reduce the high residual risk of macrovascular events and diabetes-related microvascular complications in patients managed according to current standards of care.

Declaration of financial/other relationships

J.C.F. has disclosed that he has received advisory board honoraria from Solvay. F.M.S. has disclosed that he has received research support from ISIS, and honoraria for consultancy to Abbott, Aegerion, AstraZeneca, Genentech, Genzyme, ISIS, Lilly, Merck, Roche and Solvay.

M.P.H. has disclosed that he has served on an advisory panel and/or received honoraria and/or scientific or travel grants from Abbott, AstraZeneca, Bayer, E. Lilly, Solvay Pharma, GSK, LifeScan, Menarini, MSD, Novartis, NovoNordisk, Nycomed, Pfizer, Sanofi-Aventis and Servier.

Some peer reviewers receive honoraria from CMRO for their review work. The peer reviewers of this paper have disclosed that they have no relevant financial relationships.

Acknowledgement

The authors have disclosed that they had no outside editorial assistance in preparing this manuscript.

Members of the International Steering Committee of the R3i: Australia: P Zimmet (Melbourne); GF Watts (Perth). Canada: J Davignon (Quebec). China: D Hu (Beijing); J-R Zhu (Shanghai). France: P Amarenco (Paris); MJ Chapman (Paris); P Valensi (Bondy). Germany: G Assmann (Münster); C Wanner (Würzburg). India: S Sadikot (Mumbai). Italy: P Fioretto, A Zambon (Padua). Japan: T Kadowaki (Tokyo). Philippines: R Sy (Manila). Russia: E Shlyakhto (St Petersburg). Saudi Arabia: K Al-Rubeaan (Riyadh). Spain: J Millàn Nuñez-Cortes (Madrid). Thailand: P Sritara (Bangkok). USA: WV Brown (Decatur, GA); H Ginsberg (New York, NY); J Plutzky (Boston, MA); RS Rosenson (New York, NY).