[Lipid therapy in patients with diabetes].

LDL cholesterol plays a central role in atherogenesis and LDL lowering statin therapy significantly reduces cardiovascular risk in patients with diabetes. Therefore, LDL cholesterol in current guidelines is the primary target of lipid intervention. All patients with type 2 diabetes should reach an LDL cholesterol of <100 mg/dl, the very-high risk patients with both diabetes and coronary artery disease an LDL cholesterol <70 mg/dl. Given the overwhelming body of evidence for the efficacy of statin therapy with respect to cardiovascular event prevention, LDL cholesterol should primarily be lowered by statins. Many very-high risk patients will require high-dose statin therapy to meet the stringent treatment goal of LDL cholesterol <70 mg/dl. Importantly, patients with type 2 diabetes typically exhibit a pattern of dyslipidemia with high triglycerides, low HDL cholesterol, and small, atherogenic LDL particles, which is a strong predictor of vascular events in patients with diabetes. Despite the currently limited evidence from large clinical endpoint-trials additional treatment of this diabetic dyslipidemia with niacin or fibrates therefore appears a promising option at least in the very-high risk patients with the combination of diabetes and coronary artery disease.