Lipid lowering in diabetes mellitus

The purpose of this review is to present recent information on lipid lowering in diabetes mellitus. New information from randomized clinical trials will be discussed together with implications for clinical practice. Residual risk persists despite statin therapy and additional approaches, particularly in relation to increasing HDL cholesterol will be discussed.

Recent RCTS have shown evidence of benefit and safety of more intensive LDL cholesterol lowering in patients with diabetes and established cardiovascular disease supporting guidelines for a more intensive LDL goal of therapy. A recent meta-analysis has confirmed benefit on major coronary events and ischaemic stroke in many diabetic patient subgroups, including those with type 1 disease.Despite statin treatment, cardiovascular disease residual risk remains high. After LDL the next lipoprotein goal is to increase HDL. Although there has been disappointment with the first cholesterol ester transfer protein inhibitor, there is encouraging evidence that increasing HDL with the peroxisome proliferator activator receptor (PPAR) gamma agonist, pioglitazone and nicotinic acid derivatives may contribute beyond statin therapy.

In summary the benefits of statin therapy in diabetes has been confirmed and extended such that the overwhelming majority of diabetic patients should be considered for this therapy. Increasing HDL might provide additional benefit that may further reduce cardiovascular disease risk.