Heart Attacks in Type II Diabetics

Strategies to prevent heart attacks in type 2 diabetes patients may be ineffective, harmful.
The New York Times (3/15, A11, Kolata) reports that, according to studies presented at the American College of Cardiology meeting and to be published online March 18 by the New England Journal of Medicine, "aggressive treatment strategies doctors had expected would prevent heart attacks among people with type 2 diabetes and some who are the verge of developing it have proved to be ineffective or even harmful." Still, some experts, such as Dr. Daniel Einhorn, said that the results of these studies "would not necessarily dissuade him from taking such intensive measures with individual patients." He conceded, however, "It's hard to make a case for a public health recommendation."
The Wall Street Journal (3/15, Winslow) reports that the ACCORD study of a subset of 5,518 patients found that treating hypertension to levels currently lower than recommended in practice does not lower the risk of stroke, heart attack, or death in type 2 diabetes patients. Researchers also found that Abbott's drug TriCor (fenofibrate), even though it did lower triglyceride levels, did not stop patients from having strokes and heart attacks. In another study, the drug Starlix (nateglinide) did not stop patients at high risk for type 2 diabetes from eventually developing the condition.
USA Today (3/15, Sternberg) reports that the ACCORD study findings "provoked a sharp response from Abbott vice president Eugene Sun, who said in a statement that" in patients with "abnormally high triglycerides or low levels of good cholesterol," combining "fenofibrate and simvastatin reduced heart attacks, strokes, and deaths by 31% over simvastatin alone." Meanwhile, cardiologist Steven Nissen, MD, of the Cleveland Clinic, pointed out the risk of a "higher incidence of kidney failure and other serious side effects" revealed when "doctors examined the benefits of intensive blood pressure lowering in diabetic patients and found that it failed to reduce deaths, heart attacks, and strokes taken together."