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Permalink Reply by Brian (bsc) on March 16, 2010 at 3:02pm

Actually, there has been substantial evidence that diabetics are at risk of heat attacks independent of cholesterol and blood pressure, something that has irked many in the medical establishment. Hence it is not surprising this latest finding that these drugs may not be effective. In particular, as David Nathan points out in the associated NEJM article (http://content.nejm.org/cgi/content/full/NEJMe1002322?resourcetype=...), valspartan turned out to not help heart attack rates although it does seem to work lowering blood pressure. The article further notes that efforts reducing postprandial blood sugars with nateglinide turned out to not only not work so well, but the heart attack rates in the treatment arm were higher than in the placebo, bummer. Nobody seems to want to study how increased blood sugar levels increase heart attack risk although the statistics seem pretty darn clear.

So at least in my narrow disturbed part of the world, I'll try to learn from this study, and encourage my doctors to balance the risks of aggressive medical treatment of cholesterol, blood pressure and blood sugar. Fortunately, there appears to strong evidence that lowering blood sugar blood sugar through diet, exercise and insulin use works well at reducing heart attack risk and is relatively side effect free.

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Permalink Reply by Craig on March 17, 2010 at 4:37am

Take a look at this post which talks about critically evaluating studies like this.

Even the Time article stated, "the trial was not truly a primary-prevention study designed to test whether aggressive drug treatment could prevent a first heart attack in newly diagnosed diabetes patients." and "all of the volunteers either already suffered from heart disease, or had two or more major risk factors for heart problems — including cigarette smoking, family history and high cholesterol — in addition to diabetes. That may have pushed their diabetes too far along to allow them to see any benefit from the drugs."

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Permalink Reply by Brian (bsc) on March 17, 2010 at 5:10am

I would note that these comments refer to the ACCORD study, I've not looked closely enough to see what the study population was for the NAVIGATOR which looked at valspartan and nateglinide. Those are good points in Jenny's blog. Perhaps they should be called Jenny Ruhl's Rules.

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