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ACCORD MIND: Intensive BP therapy failed to lower cognitive decline in diabetes
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Intensive blood pressure and fibrate therapy did not reduce cognitive decline among patients with long-standing type 2 diabetes at risk for cardiovascular events, according to new data from the ACCORD MIND substudy.
“The previous ACCORD MIND glycemia results showed that intensive glycemia control does not preserve cognitive function as measured by the same battery used in the present study,” researchers wrote. “The present results extend these findings to show that intensive BP management to a target [systolic blood pressure] of less than 120 mm Hg and fibrate therapy in the context of LDL-C level control are not effective in reducing cognitive decline in persons with poorly controlled type 2 diabetes at high risk for CVD.”
The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Memory in Diabetes (MIND) substudy was conducted by Jeff D. Williamson, MD, MHS, of the Roena B. Kulynych Center for Memory and Cognition Research in the department of internal medicine at Wake Forest School of Medicine in Winston-Salem, N.C., and colleagues.
The patients (mean age, 62 years; mean baseline HbA1c, 8.3%) were diagnosed with type 2 diabetes for at least 10 years and did not display clinical evidence of cognitive impairment or dementia at baseline. They were randomly assigned to a systolic BP goal of <120 mm Hg vs. <140 mm Hg (n=1,439) or to a fibrate vs. placebo therapy in patients with LDL cholesterol levels <100 mg/dL (n=1,538), according to data.
At 40 months, 503 of the 614 original patients with an acceptable baseline MRI scan (81.9%) underwent a repeated MRI to assess for total brain volume and other structural measures.
In addition, no differences in cognitive function were found in the intensive BP-lowering trial or in the fibrate trial at 40 months.
However, the total brain volume declined more in the intensive vs. standard BP-lowering group (difference, −4.4 cm3; 95% CI, −7.8 to −1.1), and fibrate therapy did not affect total brain volume compared with placebo, according to researchers.
These findings, along with previous results from the ACCORD trial, suggest no overall reduction of the rate of type 2 diabetes-related cognitive decline through intensive BP therapy or adding a fibrate to well-controlled LDL cholesterol levels.
Disclosure: Williamson reports no relevant financial disclosures. One researcher reports multiple disclosures with various entities. See the study for a full list of all relevant financial disclosures.
Perspective
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Valentin Fuster, MD, PhD
What we have learned recently is that diabetes in association with hypertension and high cholesterol can affect the brain by altering its vasculature and the brain tissue. This is manifested by imaging technology and cognitive dysfunction. The results showed that continuous decline in cognitive function and anatomical changes were not altered by intense treatment of the above risk factors.
On the one hand, these patients were at very high risk for many years. On the other hand, the damage exerted in the brain by diabetes and its associated hypertension and cholesterol disorders may be already irreversible and, if so, one could not expect significant changes with treatment.
We should avoid all these problems by treating patients once they develop prediabetes, hypertension, or high cholesterol. That is, medicine is really moving towards preventing disease and promoting health.
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