Lipid management in diabetic patients: lessons from prevention trials

Diabetes is associated with greatly enhanced risk for coronary heart disease (CHD), a correlation that justifies aggressive risk intervention in diabetic individuals. Lipid abnormalities in diabetes frequently consist of elevated triglyceride and low-density lipoprotein cholesterol levels and low high-density lipoprotein cholesterol levels. Subgroup analyses of primary and secondary prevention trials with fibrates and statins indicate that lipid modification in diabetic patients is associated with significant CHD risk reduction. In 1 angiographic study (Diabetes Atherosclerosis Intervention Study) fibrate treatment was shown to reduce the rate of atherosclerotic progression. A primary prevention study of statin treatment (West of Scotland Coronary Prevention Study) showed reduced risk for progression to diabetes in a post hoc analysis. Optimal lipid-modifying treatment in individuals with diabetes remains to be defined. Upcoming trials with diabetic cohorts will improve our understanding of how lipid treatment affects CHD risk in this patient population.