In fact, there's an editorial in the NEJM titled, "ACCORD and Risk-Factor Control in Type 2 Diabetes." What's the bottom line?
- When it comes to lipid management in patients with type 2 diabetes: The combination of fenofibrate and simvastatin did not reduce the rate of fatal cardiovascular events, nonfatal myocardial infarction, or nonfatal stroke, as compared with simvastatin alone. The ACCORD study results do not support the routine use of combination therapy with fenofibrate and simvastatin to reduce cardiovascular risk in the majority of high-risk patients with type 2 diabetes.
- When it comes to blood pressure management: In patients with type 2 diabetes at high risk for cardiovascular events, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events.
So, many questions remain unanswered, but we know that aggressive lipid management with combination therapy may not be the best approach. We also know that in blood pressure management, "lower isn't always better." The medical management of diabetes needs to be individualized for each patient.