Pharmacologic Treatment of Dyslipidemia in Diabetes: A Case for Therapies in Addition to Statins
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Purpose of Review
The purpose of the study is to review the use of statins and the role of both non-statin lipid-lowering agents and diabetes-specific medications in the treatment of diabetic dyslipidemia.
Statins have a primary role in the treatment of dyslipidemia in people with type 2 diabetes, defined as triglyceride levels >200 mg/dl and HDL cholesterol levels <40 mg/dL. A number of clinical trials suggest that treatment with a fibrate may reduce cardiovascular events. However, the results of these trials are inconsistent, probably because many of their participants did not have dyslipidemia. The choice of medications used to treat diabetes can have major implications regarding management of dyslipidemia; metformin, GLP-1 agonists, and pioglitazone all have favorable lipid effects. These agents, as well as the new SGLT2 inhibitors, may reduce cardiovascular events.
Management of dyslipidemia in people with type 2 diabetes should start with statin therapy and optimal glycemic control with agents that have favorable lipid and cardiovascular effects. We believe that there is a role for adding fenofibrate to moderate-intensity statins in selected patients with true dyslipidemia. We propose an algorithm for selecting add-on medications for diabetes (after metformin) based on lipid status.
KeywordsFibrates Cardiovascular disease Type 2 diabetes
The study was supported in part by a grant from the USPHS (HL69733). The authors thank David C. Robbins, MD, for helpful comments. JMM remembers the late William L. Isley, MD, for wisdom and inspiration in the study of lipid disorders.
Compliance with Ethical Standards
Conflict of Interest
Abeer Anabtawi declares that he has no conflict of interest.
John M. Miles reports personal fees from Sanofi for service on an advisory board.
Patrick M. Moriarty has research funding from Regeneron, Sanofi-Aventis, Pfizer, Novartis, Amgen, Ionis and Catabasis; he serves as a consultant for Genzyme, Kowa, Duke Clinical Research Institute, Eliaz Therapeutics, Aegerion, Alexion, and Esperion; and he serves on a Data Safety Monitoring Board for Lilly.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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