Few languages can be read until their alphabets are mastered

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As Charles Dickens suggests, there are steps and processes to achieving superior knowledge. Likewise, the annual ACC conference, which took place this week in Atlanta, provides its share of alphabet soup, and this maze of acronyms representing clinical trials provides conduits toward achieving mastery in clinical cardiology practice. However, maybe the biggest surprise to come out of this year’s conference is how well practices are actually doing.

Case in point, take the two ACCORD trials, embracing more than 10,251 adult participants—one assessing blood pressure, the other assessing lipid therapy in type 2 diabetics who were at high risk for cardiovascular disease.

The ACCORD blood pressure trial, which enrolled 4,733 participants, found that lowering blood pressure to below currently recommended levels did not significantly reduce the combined risk of fatal or nonfatal cardiovascular disease events in adults with type 2 diabetes who were at especially high risk for cardiovascular events.

The findings surprised the cardiology community. Even the study’s discussant, Dr. Eliot Saunders, suggested that popular ideology indicates the “lower the blood pressure, the better the outcomes,” and this trial may debunk that theory of getting below 140 mmHg for this patient population. Therefore, adding additional medications for these patients does not seem to improve outcomes.

In the ACCORD lipid trial, the researchers found that treating multiple blood lipids with combination drug therapy of a fibrate and a statin did not reduce the combined risk of cardiovascular disease events more than treatment with statin alone.

"Overall, the results of the ACCORD lipid trial do not support the use of combination therapy with a fibrate and a statin to reduce cardiovascular disease in most high-risk adults with type 2 diabetes," said principal investigator Dr. Henry N. Ginsberg.

The study’s discussant, Dr. Paul D. Thompson, said that he doesn’t think this trial will have much effect on clinical practice, since fenofibrate (Tricor; Abbott) isn’t currently being routinely used with diabetics.

In fact, based on the results of the ACCORD lipid trial, the FDA released a statement that it has made “no new conclusions or recommendations regarding the combination use of simvastatin or other statin drugs and fenofibrate.”

Also, RACE II’s findings might make it easier for physicians to achieve optimal patient care of controlling heart rates in atrial fibrillation patients, even though current guidelines suggest differently. Contrary to current guidelines, RACE II found that taking a lenient approach to controlling heart rate in patients with atrial fibrillation appears to be just as good as taking a strict approach and poses no greater risk of death or other serious complications.

“Lenient rate control is more convenient since fewer outpatient visits and exams are needed,” said principal investigator Isabelle C. Van Gelder, adding that more than two-thirds of the strict control arm patients needed multiple medications.

Based on their findings, the researchers recommended that lenient rate control may be adopted as a first choice for rate control strategy in patients with permanent atrial fibrillation, adding that this applies for high and low-risk patients.

Despite the lack of headline-grabbing, practice-changing trials at ACC.10, the research is never in vain, as it provides slight corrections and affirmations about the correct path to treating cardiology patients, and bettering one’s practice. As Dickens writes, learning the alphabet is a necessity to having a mastery of a language, which is particularly challenging when the language is less concrete.

Please view our ACC 360° portal to view the other presentations and clinical trials covered during the conference.

On these topics, or any others, please feel free to contact me.

Justine Cadet