Current Diabetes Reports

, Volume 4, Issue 5, pp 330–334 | Cite as

Combination therapy of dyslipidemia in non–insulin-dependent diabetes mellitus and the metabolic syndrome

  • Christopher M. Rembold
Article

Abstract

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.

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References and Recommended Reading

  1. 1.
    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.PubMedCrossRefGoogle Scholar
  2. 2.
    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.PubMedCrossRefGoogle Scholar
  3. 3.
    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.CrossRefGoogle Scholar
  4. 4.
    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.PubMedGoogle Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    Austin MA, Breslow JL, Hennekens CH, et al.: Low-density lipoprotein subclass patterns and risk of myocardial infarction. JAMA 1988, 260:1917–1921.PubMedCrossRefGoogle Scholar
  9. 9.
    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.PubMedGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    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.CrossRefGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    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.CrossRefGoogle Scholar
  16. 16.
    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.PubMedCrossRefGoogle Scholar
  17. 17.
    Clofibrate and niacin in coronary heart disease [no authors listed]. JAMA 1975, 231:360–381.Google Scholar
  18. 18.
    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.PubMedCrossRefGoogle Scholar
  19. 19.
    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.PubMedCrossRefGoogle Scholar
  20. 20.
    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.PubMedCrossRefGoogle Scholar
  21. 21.
    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.PubMedGoogle Scholar
  22. 22.
    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.PubMedCrossRefGoogle Scholar
  23. 23.
    Thompson PD, Clarkson P, Karas RH: Statin-associated myopathy. JAMA 2003, 289:1681–1690.PubMedCrossRefGoogle Scholar
  24. 24.
    Hooper L, Summerbell CD, Higgins JPT, et al.: Dietary fat intake and prevention of cardiovascular disease: systematic review. BMJ 2001, 322:757–763.PubMedCrossRefGoogle Scholar
  25. 25.
    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.PubMedCrossRefGoogle Scholar
  26. 26.
    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.CrossRefGoogle Scholar
  27. 27.
    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.PubMedGoogle Scholar
  28. 28.
    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.PubMedCrossRefGoogle Scholar
  29. 29.
    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.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2004

Authors and Affiliations

  • Christopher M. Rembold
    • 1
  1. 1.Cardiovascular Division, Departments of Internal Medicine and PhysiologyUniversity of Virginia Health SystemCharlottesvilleUSA

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