Blood Pressure, Cholesterol Lowering Fails to Lower
Cognitive Decline Risk in Diabetes Patients
Type 2 diabetes patients at increased risk for
decline in cognitive function due to reduced brain volume and increased
white matter lesions
Feb. 4, 2014 Type 2 diabetes patients are at risk
of cognitive decline, particularly as they grow older, due to
diabetes-related changes in the brain. Hopes that intensive blood
pressure and cholesterol lowering would reduce this risk for older
patients has been dashed, however, by new research that finds it does
not lower the risk.
Patients with type 2 diabetes are at increased risk
for decline in cognitive function due to reduced brain volume and
increased white matter lesions on brain imaging, according to the study.
The authors examined the effect of intensive treatment to lower blood
pressure (BP) and lipid levels as part of the Memory in Diabetes (MIND)
substudy of the Action to Control Cardiovascular Risk in Diabetes
Intensive blood pressure and cholesterol lowering
was not associated with reduced risk for diabetes-related cognitive
decline in older patients with long-standing type 2 diabetes mellitus,
according to a study by Jeff D. Williamson, M.D., M.H.S., of the Wake
Forest School of Medicine, Winston-Salem, N.C., and colleagues.
The trial randomized 2,977 participants without
cognitive impairment or dementia and with hemoglobin A1C levels less
than 7.5 percent to a systolic BP goal of less than 120 or less than 140
mm Hg (1,439 participants) and to a fibrate or placebo in patients with
statin-treated, low-density lipoprotein cholesterol levels less than 100
mg/dL (1,538 participants).
Researchers assessed cognition at beginning of the
study and after 20 and 40 months. Also, 503 participants underwent
baseline and 40-month brain magnetic resonance imaging to look for
changes in total brain volume (TBV) and other structural measures of
There were no differences in cognitive function in
the intensive BP-lowering trial (<120 target) or in the placebo groups.
At 40 months, the intensive BP intervention group had a lower TBV
compared with the standard BP intervention group. Fibrate therapy had no
effect on TBV.
During the past two decades, the belief that more
intensive treatment strategies for controlling T2DM-related
comorbidities (related illnesses), such as hyperglycemia, hyperlipidemia
and hypertension, would reduce clinical complications has driven large
investment in new medications for this disease syndrome, the study
These results do not negate other evidence that
intensive strategies to control BP and lipid levels may be indicated for
other conditions such as stroke or coronary heart disease. However, this
randomized clinical trial in 2,977 older adults with a mean baseline
Mini-Mental State Examination score higher than 27, a mean HbA1Clevel of 8.3 percent, and long-term T2DM shows no overall
reduction of the rate of T2DM-related cognitive decline through
intensive BP therapy or adding a fibrate to well-controlled LDL-C
This study was supported by the National Institute
of Aging and the National Heart, Lung and Blood Institute of the
National Institutes of Health.
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