Jama logoPatients with diabetes may often face a heightened risk of developing cardiovascular disease. To lessen this risk physicians supposedly employ an aggressive strategy to treat high low-density lipoprotein commonly known as LDL or bad cholesterol and blood pressure levels. But an expert from RAND Corp., Arlington, Va., apparently discovered a mathematical model suggesting that the aggressive strategy to lower blood pressure or cholesterol levels neither benefit nor harm some patients with diabetes.

Initially the investigators aimed to build a mathematical model to study if all patients with diabetes benefit from the aggressive treatment equally or not. The authors scrutinized data gathered from the National Health and Nutrition Examination Survey which encompassed participants aged 30-75 years. These participants supposedly represented approximately 8 million individuals with diabetes in the 1990s.

During this time period aggressive treatment was seldom considered. During the course of the study Justin W. Timbie, Ph.D., RAND Corp. and his colleagues revealed the segregation of participants with low LDL levels and low blood pressure. It then appeared that the average LDL-C level was probably 151 milligrams per deciliter and on the other hand the average blood pressure seemed to be 144/79 millimeters of mercury.

The authors revealed, “These recommendations, which are based on the average results of trials evaluating the relative benefits of intensive risk factor control, are not tailored to an individual’s underlying cardiovascular disease risk. While this [risk stratification] approach is often advocated in patients without diabetes mellitus, there is an implicit assumption that all patients with diabetes mellitus are at equally high risk, requiring all patients to be treated aggressively.”

The authors then predicted the outcome of patients subjected to extreme treatment till their LDL-C levels appeared to decrease to 100 milligrams per deciliter with blood pressure to 130/80 millimeters of mercury. Treating to these targets possibly achieved 1.5 years of life in perfect health with LDL-C levels and 1.35 for blood pressure.

The investigators commented, “Given the large set of factors that moderate the benefit of treatment intensification, including patients’ underlying cardiovascular disease risk, the diminishing efficacy of combination therapy and increasing polypharmacy and adverse effects, we recommend a strategy of tailoring treatments to individual patients on the basis of their expected benefit of intensifying treatment. Current treatment approaches that encourage uniformly lowering risk factors to common target levels can be both inefficient and cause unnecessary harm.”

However, a reduction in 1.42 quality-adjusted life years for LDL-C and 1.16 for blood pressure was noted. This decline appeared after the treatment-related harms were scrutinized. Along with muscle pain due to the intake of statins, safety hazards of taking multiple medications were seemingly caused by the treatment.

The authors explained that only patients belonging to the very high-risk group benefited from the treatment. But almost three-fourth of patients with an average risk gained very little. After listing various threats of employing the treatment the investigators supposedly discovered cases wherein intensifying treatment decreased the expected benefits.

The study is published in the June 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.