Accueil
> Essais thérapeutiques
> ACCORD
23 juin 2016
ACCORD? : Action to Control Cardiovascular Risk in Diabetes.
Abstract
Une cohorte de 4733 patients diabétiques de type 2 ont été randomisés pour un traitement intensif ciblant une PAS? <120 mmHg ou un traitement usuel ciblant une PAS < 140 mmHg. Le critère de jugement principal était un critère combiné, associant décès cardiovasculaire, IDM? et AVC? non fatals. Après 1 an, la PAS moyennée était 119,3 mmHg dans le groupe intensif et 133,5 mmHg dans le groupe usuel. L’incidence? annuelle du critère principal était 1,87% dans le groupe intensif et 2,09 dans le groupe usuel (HR? 0,88 [CI], 0.73 - 1.06 ; P=0.20). L’incidence annuelle de décès de toutes causes était de 1,28% et 1,19% (hazard ratio, 1.07 ; 95% CI, 0.85 - 1.35 ; P=0.55). L’incidence annuelle d’AVC, un critère pré-spécifié était de 0,32% et 0,53% (hazard ratio, 0.59 ; 95% CI, 0.39 - 0.89 ; P=0.01). Des effets indésirables graves sont survenus chez 3,3% des patients dans le groupe intensif et 1,3% dans le groupe usuel.
Chez les patients diabétiques de type 2, l’intensification du traitement antihypertenseur ne modifie pas la mortalité et la morbidité cardiovasculaire, à l’exception d’une réduction significative des AVC au prix d’une moins bonne tolérance.
Références :
ACCORD? Study Group, Cushman WC, Evans GW, Byington RP, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010 ;362:1575-85 20228401
Action to Control Cardiovascular Risk in Diabetes Follow-On (ACCORDION) Eye Study Group and the Action to Control Cardiovascular Risk in Diabetes Follow-On
(ACCORDION) Study Group. Persistent Effects of Intensive Glycemic Control on Retinopathy in Type 2 Diabetes in the Action to Control Cardiovascular Risk in
Diabetes (ACCORD?) Follow-On Study. Diabetes Care. 2016 ;39(7):1089-100. 27289122
Nadkarni GN, Rao V, Ismail-Beigi F, et al.. Association of Urinary Biomarkers of Inflammation, Injury, and Fibrosis with Renal Function Decline : The ACCORD? Trial. Clin J Am Soc Nephrol. 2016 May 17. pii : 27189318
Drake TC, Hsu FC, Hire D, et al. Factors associated with failure to achieve a glycated haemoglobin target of <8.0%> 26435375
Siraj ES, Rubin DJ, Riddle MC, et al. ; ACCORD? Investigators. Insulin Dose and Cardiovascular Mortality in the ACCORD? Trial. Diabetes Care. 2015 ;38(11):2000-8. 26464212
Chen LY, Bigger JT, Hickey KT, et al.. Effect of Intensive Blood Pressure Lowering on Incident Atrial Fibrillation and P-Wave Indices in the ACCORD? Blood Pressure Trial. Am J Hypertens. 2015 Oct 16. pii:hpv172. 26476086
Chow LS, Chen H, Miller ME, Marcovina SM, Seaquist ER. Biomarkers associated with severe hypoglycaemia and death in ACCORD?. Diabet Med. 2015 -26261902
Hempe JM, Liu S, Myers L, McCarter RJ, Buse JB, Fonseca V. The hemoglobin glycation index identifies subpopulations with harms or benefits from intensive
treatment in the ACCORD? trial. Diabetes Care. 2015 ;38(6):1067-74. 25887355
Chow LS, Chen H, Miller ME, Marcovina SM, Seaquist ER. Biomarkers related to severe hypoglycaemia and lack of good glycaemic control in ACCORD?. Diabetologia. 2015 ;58(6):1160-6. 25652389
Buse JB. Glycemic Targets in Diabetes Care : Emerging Clarity after Accord. Trans Am Clin Climatol Assoc. 2015 ;126:62-76. Review. 26330660
Gerstein HC, Miller ME, Ismail-Beigi F, Largay J, McDonald C, Lochnan HA, Booth GL ; ACCORD? Study Group. Effects of intensive glycaemic control on ischaemic
heart disease : analysis of data from the randomised, controlled ACCORD? trial. Lancet. 2014 Nov 29 ;384(9958):1936-41
Mottl AK, Pajewski N, Fonseca V, et al. The degree of retinopathy is equally predictive for renal and macrovascular outcomes in the ACCORD? Trial. J Diabetes Complications. 2014 Nov-Dec ;28(6):874-9. 25123755
Punthakee Z, Miller ME, Simmons DL, et al. ; ACCORD? Group of Investigators. Durable change in glycaemic control following intensive
management of type 2 diabetes in the ACCORD? clinical trial. Diabetologia. 2014 Oct ;57(10):2030-7. 24985147
Margolis KL, O’Connor PJ, Morgan TM, et al. Outcomes of combined cardiovascular risk factor management
strategies in type 2 diabetes : the ACCORD? randomized trial. Diabetes Care. 2014 Jun ;37(6):1721-8. 24595629
Miller ME, Williamson JD, Gerstein HC, et al. ; ACCORD? Investigators. Effects of randomization to intensive glucose control on adverse events, cardiovascular disease, and mortality in older versus younger adults in the ACCORD? Trial. Diabetes Care. 2014 ;37(3):634-43. 24170759
Barzilay JI, Howard AG, Evans GW, Fleg JL, Cohen RM, Booth GL, Kimel AR, Pedley CF, Cushman WC. Intensive blood pressure treatment does not improve
cardiovascular outcomes in centrally obese hypertensive individuals with diabetes : the Action to Control Cardiovascular Risk in Diabetes (ACCORD?) Blood Pressure Trial. Diabetes Care. 2012 ;35(7):1401-5. 22723577
Bonds DE, Miller ME, Dudl J, et al. Severe hypoglycemia symptoms, antecedent behaviors, immediate consequences and association with glycemia medication usage : Secondary analysis of the ACCORD? clinical trial data. BMC Endocr Disord. 2012 ;12:5. 22646230
Punthakee Z, Miller ME, Launer LJ, et al. ; ACCORD? Group of Investigators ; ACCORD?-MIND Investigators. Poor cognitive function and risk of severe hypoglycemia in type 2 diabetes : post hoc epidemiologic analysis of the ACCORD? trial. Diabetes Care. 2012 Apr ;35(4):787-93. 22374637
Seaquist ER, Miller ME, Bonds DE, Feinglos M, Goff DC? Jr, Peterson K, Senior P ; ACCORD? Investigators. The impact of frequent and unrecognized hypoglycemia on
mortality in the ACCORD? study. Diabetes Care. 2012 Feb ;35(2):409-14. 22179956
Zoungas S, Woodward M. Diabetes. Insights from the extended follow-up of the ACCORD? trial. Nat Rev Cardiol. 2011 Jun ;8(6):308-10. 21502962
Ismail-Beigi F, Craven T, Banerji MA, et al. ; ACCORD? trial group. Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes : an analysis of the ACCORD? randomised trial. Lancet. 2010 ;376(9739):419-30. Epub 2010 Jun 30. Erratum in : Lancet. 2010 ;376(9751):1466. 20594588
Bonds DE, Miller ME, Bergenstal RM, et al. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes : retrospective
epidemiological analysis of the ACCORD? study. BMJ. 2010 ;340:b4909. 20061358
Williamson JD, Miller ME, Bryan RN, et al. ; ACCORD? Study Group. The Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes Study (ACCORD?-MIND) :
rationale, design, and methods. Am J Cardiol. 2007 ;99(12A):112i-122i. 17599421.