Combination therapy of dyslipidemia in non–insulin-dependent diabetes mellitus and the metabolic syndrome
- Christopher M. Rembold MD
- … show all 1 hide
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Non–insulin-dependent diabetes mellitus (NIDDM) and the metabolic syndrome separately and additively increase the risk for atherosclerotic cardiovascular disease. Considering the high cardiovascular risk associated with NIDDM and the metabolic syndrome, aggressive therapy of dyslipidemia with tailored combination therapy should be considered given informed consent and discussion of risks. In addition to statins, niacin, and fibrates, therapies shown to decrease the risk for atherosclerotic cardiovascular disease include omega-3 fatty acids, diet, exercise, and optimal blood pressure control with thiazides and blockers of the renin-angiotensin system. These therapies should also be considered to reduce the high cardiovascular risk associated with NIDDM and the metabolic syndrome.
- Haffner SM, Lehto S, Ronnemaa T, et al.: Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998, 339:229–234. CrossRef
- Isomaa B, Almgren P, Tuomi T, et al.: Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001, 24:683–689. Diagnosis of the metabolic syndrome is just as important in predicting risk as the diagnosis of NIDDM. Each carries an additive risk for cardiovascular events. CrossRef
- Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001, 285:2486–2497. CrossRef
- Lamarche B, Tchernof A, Moorjani S, et al.: Small, dense low-density lipoprotein particles as a predictor of the risk of ischemic heart disease in men. Prospective results from the Quebec Cardiovascular Study. Circulation 1997, 95:69–75.
- Despres JP, Lemieux I, Dagenais GR, et al.: HDL-cholesterol as a marker of coronary heart disease risk: the Quebec cardiovascular study. Atherosclerosis 2000, 153:263–272. CrossRef
- Assmann G, Schulte H, von Eckardstein A: Hypertriglyceridemia and elevated lipoprotein(a) are risk factors for major coronary events in middle-aged men. Am J Cardiol 1996, 77:1179–1184. CrossRef
- Barter P, Kastelein J, Nunn A, Hobbs R: High density lipoproteins (HDLs) and atherosclerosis: the unanswered questions. Atherosclerosis 2003, 168:195–211. Great review on all aspects of HDL. CrossRef
- Austin MA, Breslow JL, Hennekens CH, et al.: Low-density lipoprotein subclass patterns and risk of myocardial infarction. JAMA 1988, 260:1917–1921. CrossRef
- Vijan S, Hayward RA: Pharmacologic lipid-lowering therapy in type 2 diabetes mellitus: background paper for the American College of Physicians. Ann Intern Med 2004, 140:650–658.
- Crouse JR, Frohlich J, Ose L, et al.: Effects of high doses of simvastatin and atorvastatin on high-density lipoprotein cholesterol and apolipoprotein A-I. Am J Cardiol 1999, 83:1476–1477, A7. CrossRef
- Collins R, Armitage J, Parish S, et al.: MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002, 360:7–22. CrossRef
- Sever PS, Dahlof B, Poulter NR, et al.: Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 2003, 361:1149–1158. CrossRef
- Frick MH, Elo O, Haapa K, et al.: Helsinki Heart Study: primary prevention trial with gemfibrozil in middle-aged men with dyslipidemia. N Engl J Med 1987, 317:1237–1245. CrossRef
- Manninen V, Elo O, Frick MH, et al.: Lipid alterations and decline in the incidence of coronary heart disease in the Helsinki Heart Study. JAMA 1988, 260:641–651. CrossRef
- Koshinen P, Manttari M, Manninen V, et al.: Coronary heart disease incidence in NIDDM patients in the Helsinki Heart Study. Diabetes Care 1992, 15:820–825. CrossRef
- Robins SJ, Collins D, Wittes JT, et al.: Relation of gemfibrozil treatment and lipid levels with major coronary events: VA-HIT: a randomized controlled trial. JAMA 2001, 285:1585–1591. CrossRef
- Clofibrate and niacin in coronary heart disease [no authors listed]. JAMA 1975, 231:360–381.
- Canner PL, Berge KG, Wenger NK, et al.: Fifteen-year mortality in coronary drug project patients: long-term benefit with niacin. J Am Coll Cardiol 1986, 8:1245–1255. CrossRef
- Elam MB, Hunninghake DB, Davis KB, et al.: Effect of niacin on lipid and lipoprotein levels and glycemic control in patients with diabetes and peripheral arterial disease: the ADMIT Study: a randomized trial. JAMA 2000, 284:1263–1270. CrossRef
- Brown G, Albers JJ, Fisher LD, et al.: Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med 1990, 323:1289–1298. CrossRef
- Zhao XQ, Yuan C, Hatsukami TS, et al.: Effects of prolonged intensive lipid-lowering therapy on the characteristics of carotid atherosclerotic plaques in vivo by MRI: a case-control study. Arterioscler Thromb Vasc Biol 2001, 21:1623–1629. Combination antidyslipidemic therapy changes the characteristic of the arterial wall, reducing plaque lipid. This may explain the reduction in cardiovascular events.
- Brown BG, Zhao XQ, Chait A, et al.: Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med 2001, 345:1583–1592. Only randomized trial of niacin and statins. There was a 70% reduction in events. CrossRef
- Thompson PD, Clarkson P, Karas RH: Statin-associated myopathy. JAMA 2003, 289:1681–1690. CrossRef
- Hooper L, Summerbell CD, Higgins JPT, et al.: Dietary fat intake and prevention of cardiovascular disease: systematic review. BMJ 2001, 322:757–763. CrossRef
- Morgan SA, Sinclair AJ, Odea K: Effect on serum-lipids of addition of safflower oil or olive oil to very-low-fat diets rich in lean beef. J Am Diet Assoc 1993, 93:644–648. CrossRef
- Valagussa F, Franzosi MG, Geraci E, et al.: Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet 1999, 354:447–455. CrossRef
- de Lorgeril M, Salen P, Martin JL, et al.: Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999, 99:779–785.
- Singh RB, Dubnov G, Niaz MA, et al.: Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial. Lancet 2002, 360:1455–1461. A Mediterranean diet reduced cardiovascular events and improved the metabolic syndrome. CrossRef
- Vijan S, Hayward RA: Treatment of hypertension in type 2 diabetes mellitus: blood pressure goals, choice of agents, and setting priorities in diabetes care. Ann Intern Med 2003, 138:593–602.
- Combination therapy of dyslipidemia in non–insulin-dependent diabetes mellitus and the metabolic syndrome
Current Diabetes Reports
Volume 4, Issue 5 , pp 330-334
- Cover Date
- Print ISSN
- Online ISSN
- Current Medicine Group
- Additional Links
- Author Affiliations
- 1. Cardiovascular Division, Departments of Internal Medicine and Physiology, University of Virginia Health System, Box 801395, 22908-1395, Charlottesville, VA, USA