Several studies in patients with diabetes and known cardiovascular disease (CVD) have suggested that lower is better for both LDL cholesterol (LDL-C) levels and systolic blood pressure (SBP). In an NIH-funded study, researchers assessed whether lower-risk people with diabetes and without known heart disease also benefit from lower targets.
A total of 499 adult Native Americans with type 2 diabetes but without known CVD were randomized to aggressive (LDL-C level,
70 mg/dL; SBP, 
115 mm Hg) or standard treatment targets (LDL-C level, 
100 mg/dL; SBP, 130 mm Hg), using stepwise drug treatment approaches and lifestyle modifications. Carotid intima–media thickness (IMT) and left ventricular function were assessed at baseline, 18 months, and 36 months. Although mean LDL-C levels and SBP were close to target levels for each group, target levels were achieved at >75% of visits by fewer than half the participants who received aggressive therapy. The group who received aggressive therapy showed a significant reduction in mean carotid IMT, whereas the group who received standard therapy experienced a slight increase. LV mass decreased in both groups, but it decreased significantly more in the group who received aggressive therapy. The two groups did not differ in the rate of fatal and nonfatal CVD events, which was roughly 1.5 per 100 person-years.Comment: Although these results with surrogate endpoints are intriguing, the study was too small and too short to show a difference in actual clinical endpoints. In addition, implementing these aggressive targets in actual clinical practice could be difficult, because fewer than half the participants in the aggressive-therapy groups achieved these targets even with intense monitoring.
— Thomas L. Schwenk, MD
Published in Journal Watch General Medicine April 24, 2008