Low-density lipoprotein lowering in type 2 diabetes mellitus: how to know how low to go

Getting low-density lipoprotein to the right level in patients with type 2 diabetes should be relatively easy, given the potent pharmacological therapy that is available and the fact that low-density lipoprotein C is typically normal in these patients. Getting it right means getting the target for therapy right, however. The article examines the criteria that should be used to make this choice.

In comparing different parameters, three criteria, in particular, need to be taken into account: the on-treatment predictive value of any parameter; the value relative to the population of one parameter compared with another, namely which is more deviant from the norm; and the concurrent level of high-density lipoprotein. The evidence from the low-density lipoprotein-lowering trials indicates that low-density lipoprotein C is not nearly as good as non-high-density lipoprotein C as a guide for the adequacy of low-density lipoprotein lowering, or, better still, apoB, with the apoB/apoA-I ratio being clearly the best of all.

The evidence from the major clinical trials indicates the best single index of the adequacy of low-density lipoprotein lowering is the apoB/apoA-I ratio. Clinical practice should adapt to clinical evidence and, therefore, guidelines should be based on apolipoproteins rather than the conventional cholesterol indices.