Statins are first-line therapy for reducing LDL cholesterol levels in persons with diabetes and they are generally well tolerated. They have the advantage of lowering VLDL cholesterol as well as LDL cholesterol; thus they can assist in attaining the non-HDL-cholesterol goal when triglyceride levels are ¡Ý200 mg/dL. Bile acid sequestrants also are effective LDL-lowering drugs in persons with diabetes. Their potential utility for LDL lowering either as monotherapy or in combination with statins should not be overlooked. They generally are not contraindicated simply because of their tendency to raise triglycerides. Nonetheless, triglyceride levels should be monitored.



Fibrates favorably modify diabetic dyslipidemia. They are well tolerated, and do not worsen hyperglycemia. For more detailed info please visit http://www.heartdiseasesecret.com

They probably produce some reduction in CHD risk, and could be used in persons who have low LDLcholesterol levels and atherogenic dyslipidemia. In addition, they can be combined with statins to improve the overall lipoprotein pattern. For many years, fibrates were considered first-line therapy for persons with diabetes. However, the results of recent clinical trials now favor use of statins before fibrates in most persons. Still, the combination of statin + fibrate is attractive in persons with diabetes who have atherogenic dyslipidemia but in whom LDL lowering is required to achieve the LDL-cholesterol goal. Clinical trials are currently underway to test the efficacy of statin + fibrate in treatment of diabetic dyslipidemia.

Nicotinic acid also has a favorable effect on diabetic dyslipidemia. Recent clinical trials in persons with diabetes indicated that low doses of nicotinic acid are accompanied by only modest deterioration in glucose control with no changes in HbA1C levels.

Unfortunately, nicotinic acid therapy can increase insulin resistance and clinical experience has shown that in rare instances, diabetic dyslipidemia is worsened with nicotinic acid therapy.

Treatment with hypoglycemic agents also can improve diabetic dyslipidemia. Insulin therapy, sulfonyl ureas, metformin, and glitazones can all lower triglyceride levels. Although they may not be as effective as fibrates in modifying atherogenic dyslipidemia, control of hyperglycemia should be maximized before considering a fibrate in combined lipid-lowering drug therapy.

If hypertriglyceridemia can be adequately controlled by glucose-lowering therapy, a lipid-lowering drug may not be needed.