Lipid-lowering therapy in type 2 diabetes: A review of the evidence

Abstract

Current treatment guidelines highlight the importance of lipid-lowering therapy in reducing cardiovascular risk in patients with type 2 diabetes. Statins have been shown to be effective in reducing cardiovascular risk in patients with diabetes, but they fail to address adequately the coronary risk associated with low plasma levels of high-density lipoprotein cholesterol (HDL-C) and elevated triglycerides, commonly reported in these patients. Fibrates are effective against all three components of the atherogenic dyslipidaemic profile that characterises type 2 diabetes. Clinical studies such as the Veterans Affairs HDL Intervention Trial (VA-HIT), which showed a marked and statistically significant reduction in coronary heart disease death and stroke, as well as the Diabetes Atherosclerosis Intervention Study (DAIS), which showed that treatment with fenofibrate produced significantly less progression in markers of focal coronary artery disease, support a role for fibrate therapy in cardiovascular risk reduction in type 2 diabetes. Together, these data provided the rationale for the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial, the largest study to date in patients with type 2 diabetes.