These days, preventing heart problems can seem like a game of limbo—except the question isn't how low can you go, but how low should you go. A recent cardiovascular disease prevention trial, the Stop Atherosclerosis in Native Diabetics Study, or SANDS, pitted standard cholesterol- and blood pressure-lowering therapies against a more aggressive regimen in 500 Native Americans, 40 years or older, with type 2 diabetes and no previous cardiovascular events. The victor? Well, it may be a draw. Researchers found that aggressive therapy caused the lining of neck and heart blood vessels to thin out, an indicator that atherosclerotic plaques may be going away. Based on these measures, the aggressive group appeared healthier. But when the researchers looked at numbers of cardiovascular events like heart attacks and strokes in the two groups, the results were the same. So, says lead author Barbara Howard, PhD, president of the MedStar Research Institute in Hyattsville, Md., "the standard targets may do pretty darn well."

But what about the vessel improvements? "You may get a small benefit if you go lower," says Howard, "but would it be worth the extra money for drugs and the risk of side effects?"

Because this trial included only Native Americans, questions remain about whether these findings would extend to other populations. Howard and other researchers are looking to findings from a larger, more diverse trial to help settle these issues. The results of that study, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, will be announced in 2010.

The SANDS study was published Apr. 9, 2008, in the Journal of the American Medical Association.