McMaster University

McMaster University

Faculty of
Health Sciences

McMaster University awarded more than $20M to test ways to lower risk of heart disease and stroke in adults with diabetes

Published: February 20, 2003

A professor of McMaster University's Faculty of Health Sciences is the lead investigator for the $20 million Canadian portion of a major study of adults with Type 2 diabetes.

Dr. Hertzel Gerstein, professor of medicine, and head of endocrinology at Hamilton Health Sciences, will lead 11 Canadian university, hospital and community-based clinics participating in the international study, to test three promising approaches to lower the risk of heart disease and stroke in adults with Type 2 diabetes. He will be working in collaboration with Dr. Salim Yusuf, professor of medicine, and Dr. Sarah Capes, assistant professor of medicine, at McMaster University.

The ACCORD (Action to Control Cardiovascular Risk in Diabetes) study is funded by two American medical institutes, the National Heart, Lung, and Blood Institute and the National Institute on Diabetes and Digestive and Kidney Diseases, which are both part of the U.S. National Institutes of Health. There are a total of 70 sites in the U.S. and Canada; participants in Hamilton are being followed through the McMaster hospital site of Hamilton Health Sciences.

Type 2 diabetes, previously called adult onset or non-insulin-dependent diabetes mellitus, is a disorder in which the muscle and fat cells do not use insulin properly. It is associated with older age, obesity, and a family history of diabetes.

"Type 2 diabetes accounts for a large proportion of all heart attacks, strokes, deaths and other health problems in Canada," says Dr. Gerstein. "This large comprehensive study of 10,000 people, including 1,440 people in Canada alone, will clearly determine the role of intensive glucose, blood pressure and lipid control as a way to safely reduce these serious consequences."

The full study started this month and runs until June 2009. Most participants can expect their involvement to last from 5.5 to 8.5 years. ACCORD involved an initial pilot study of 1,184 participants (177 of those were in Canada). The results from that phase were used to refine the current protocol.

Currently, about 19.5 million people in North America have Type 2 diabetes, including two million in Canada, and as many as one million in Canada who are affected but undiagnosed. People with Type 2 diabetes die of cardiovascular diseases at rates two to four times higher than those who do not have diabetes. They also experience more nonfatal heart attacks and strokes

Type 2 diabetes is most common in women with a history of diabetes during pregnancy and people who lead a sedentary lifestyle. Also at particularly high risk are First Nation's people, African Americans, Hispanic/Latino Americans, Asian Americans and Pacific Islanders.

ACCORD will test 3 medical treatment strategies.

Blood sugar

ACCORD will determine whether lowering blood glucose to a goal closer to normal than called for in current guidelines reduces risk of cardiovascular disease. The study will determine effects on cardiovascular disease of that level compared with a level that is usually targeted.

Blood pressure

Many people with Type 2 diabetes have high blood pressure. The blood pressure part of the trial will determine the effects of lowering blood pressure in the context of good blood sugar control. ACCORD will determine whether lowering blood pressure to normal (<120mmHg systolic) will reduce risk of cardiovascular disease better compared to a usually targeted level in current clinical practice, i.e., below the definition of hypertension (<140mmHg systolic).

Blood Fats

Many people with diabetes have high levels of LDL ("bad") cholesterol and triglycerides, as well as low levels of HDL ("good") cholesterol. ACCORD participants who are selected for this part of the trial will be assigned to an intervention that improves blood fat levels. This part of the study will look at the effects of lowering LDL cholesterol and blood triglycerides and increasing HDL cholesterol compared to an intervention that only lowers LDL cholesterol, all in the context of good blood sugar control. A drug from a class of drugs called "fibrates" will be used to lower triglycerides and increase HDL cholesterol, whereas a drug from the class of drugs called "statins" will be used to lower the LDL cholesterol.

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