Advances in diabetes for the millennium: diabetes and cholesterol.

The development of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors has made it possible to significantly lower cholesterol and low-density lipoprotein (LDL) levels. A moderate reduction of LDL levels has resulted in substantial decreases on the order of 30% to 40% in cardiovascular mortality. It is yet unknown whether a reduction of cholesterol levels below normal levels can counteract the increased cardiovascular mortality associated with diabetes. Studies thus far do demonstrate at least as much benefit in diabetic as in nondiabetic patients from cholesterol-lowering therapy. Pharmacologic therapy does have side effects. It is important to consider possible adverse effects as we progressively increase the dosage levels of various agents to meet the continually dropping LDL target levels in diabetic patients.