Fibrate therapy in the management of diabetic dyslipidemia: there is no ACCORD to be found.

Mixed dyslipidemia is a complex clinical entity that contributes significantly to the increased risk for cardiovascular morbidity and mortality that is observed in patients with type 2 diabetes mellitus. Insulin resistance is associated with reduced serum lipoprotein lipase activity, increased serum levels of very low-density lipoproteins and triglyceride, low serum high-density lipoproteins, and increased concentrations of small, dense low-density lipoproteins. Combinations of medications are frequently required in order to achieve guideline-specified goals for the various lipid fractions of diabetic patients. The fibric acid derivatives (fibrates) are effective agents for raising serum levels of high-density lipoproteins and decreasing levels of triglycerides. A number of trials have demonstrated that among patients with high triglycerides and low HDL, fibrates do beneficially impact cardiovascular morbidity in diabetic and nondiabetic individuals. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial suggests that the addition of fenofibrate to ongoing statin therapy in patients with type 2 diabetes mellitus offers limited benefit.