[The vascular risk in the diabetic: the lipid factor, from epidemiologic data to intervention trials]

It might seem likely that the lipid abnormalities observed in diabetes could be treated more efficiently by fibrates than by statins, whereas subgroup analysis in three intervention trials has shown that statins prevent cardiovascular diseases in diabetic patients. The magnitude of relative risk reduction in these trials was similar to that observed in non-diabetic populations, but the greater absolute risk for diabetic patients led to increased absolute benefit. These data concerned only secondary prevention in well-controlled diabetic patients with combined hyperlipidaemia. Subgroup analysis based on LDL-cholesterol concentration in cardiovascular prevention trials with statin and the results of fibrate trials performed in the general population suggest that fibrates could still be recommended for hypertriglyceridaemic diabetic patients whose LDLc is lower than 1.4 g/l. This hypothesis needs to be tested in the light of results of ongoing fibrate trials specifically conducted in diabetic patients.