Clinical significance of recent lipid trials on reducing risk in patients with type 2 diabetes mellitus.

Type 2 diabetes mellitus is a significant risk factor for cardiovascular disease and is associated with significant cardiovascular morbidity and mortality. Current guidelines suggest lifestyle modification and at least a 30%-40% reduction of low-density lipoprotein (LDL) cholesterol with drug therapy, to a target level of <100 mg/dL. Additional secondary therapeutic targets include increasing high-density lipoprotein (HDL) cholesterol and lowering triglycerides. Although the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) remain first-line therapy, combination therapy with statins and fibrates or niacin is often needed to achieve target levels in patients with diabetes. Statins significantly lower LDL and decrease the relative risk for nonfatal myocardial infarction (MI) or coronary artery disease death. Clinical trials have demonstrated that in high-risk patients, such as those with diabetes, monotherapy with statins reduces overall cardiovascular events by 30%-40%. Fibrates have modest effects to lower LDL, but they significantly increase HDL and reduce triglycerides, they may improve glucose tolerance, and they have been shown to reduce nonfatal MI by 25%. Although data are limited, the combination of a statin and fenofibrate significantly reduced LDL, reduced triglycerides, and increased HDL compared with a statin alone. It is hoped that ongoing trials will demonstrate the clinical outcomes benefits of combination therapy in patients with diabetes.