[Hypolipidemic drugs and diabetes mellitus]

Diabetes mellitus associates with high cardiovascular risk. The absolute values of cardiovascular risk tend to be even higher than as calculated from the SCORE tables. Recent randomized clinical trials 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. The pathological combination of several lipoprotein metabolism abnormalities and the need to reach lipoprotein goals need combination therapy of hypolipidemic drugs with different mechanisms of action. 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 cholesteryl-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.