Implications of the ACCORD Lipid study: perspective from the Residual Risk Reduction Initiative (R3i)

Most type 2 diabetes patients remain at high residual risk of cardiovascular events despite best treatment. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial aimed to address this challenge, by evaluating whether intensive control of glycaemia and high blood pressure, or as in ACCORD Lipid, extending lipid treatment with the combination of fenofibrate plus simvastatin, could impact this risk. ACCORD Lipid showed that treatment beyond low-density lipoprotein cholesterol was not appropriate for most type 2 diabetes patients. However, a subgroup analysis did suggest additional benefit in patients with atherogenic dyslipidaemia, the combination of high baseline triglycerides (>= 204 mg/dL or 2.3 mmol/L) and low baseline plasma levels of high-density lipoprotein cholesterol (<= 34 mg/dL or 0.88 mmol/L). This finding is concordant with subgroup analyses from other fibrate trials in patients with high triglycerides and low plasma levels of high-density lipoprotein cholesterol, and consistent with current guideline recommendations. This commentary from the Residual Risk Reduction Initiative (R(3)i), discusses the ACCORD Lipid study results and the next steps to establish the clinical relevance of these findings.