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The British Journal of Diabetes & Vascular Disease
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Rational therapy of mixed dyslipidaemia in a patient with diabetes

Charles Reasner

University of Texas Health Science Center and Medical Director, Texas Diabetes Institute, 701 S. Zarzamora, San Antonio, TX 78207, USA, Charles.Reasner{at}uhs-sa.com

Diabetic dyslipidaemia refers to the triad of elevated levels of triglycerides and small, dense LDL-C particles and low levels of HDL-C. These lipid abnormalities are largely responsible for the increased risk of cardiovascular complications in patients with diabetes. This case study outlines a rational approach to the treatment of each of these lipid abnormalities and emphasises the importance of both lowering the LDL-C and raising the HDL-C in high-risk individuals. Combination drug therapy will often be necessary to achieve treatment goals in these patients.

Key Words: diabetic dyslipidaemia • atherogenic dyslipidaemia • statins • fibrates • niacin • diabetes.

References

  • Steiner G. Atherosclerosis, the major complication of diabetes. Adv Exp Med Biol 1985;189:277-97.[Web of Science][Medline] [Order article via Infotrieve]
  • American Diabetes Association. Dyslipidemia management in adults with diabetes. Diabetes Care 2004;27(suppl 1):S68-S71.[CrossRef][Medline] [Order article via Infotrieve]
  • Haffner SM, Lehto S., Rönnemaa T., Pyörälä K., Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998;339:229-34.[Abstract/Free Full Text]
  • Malmberg K., Yusuf S., Gerstein HC et al. for the OASIS Registry Investigators. Impact of diabetes on long-term prognosis in patients with unstable angina and non-Q-wave myocardial infarction: results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) registry. Circulation 2000;102:1014-19.[Abstract/Free Full Text]
  • Miettinen H., Lehto S., Salomaa V. et al. for the FINMONICA Myocardial Infarction Register Study Group. Impact of diabetes on mortality after the first myocardial infarction. Diabetes Care 1998;21:69-75.[Abstract]
  • American Heart Association, American Stroke Association. Heart Disease and Stroke Statistics-2004 Update. Available at: http://www.american-heart.org/downloadable/heart/1072969766940HSStats2004Update.pdf Accessed January 23, 2004.
  • 7. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. National Cholesterol Education Program (Adult Treatment Panel III): Full report. NIH Publication No. 02-5215. September 2002. Bethesda, MD: NIH National Heart, Lung, and Blood Institute; 2002.
  • American Diabetes Association. Management of dyslipidemia in adults with diabetes. Diabetes Care 2002;25(suppl 1):S74-S77.[CrossRef]
  • Pearson TA, Laurora I., Chu H., Kafonek S. The Lipid Treatment Assessment Project (L-TAP): a multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid-lowering therapy and achieving low-density lipoprotein cholesterol goals. Arch Intern Med 2000;160:459-67.[Abstract/Free Full Text]
  • Grant RW, Cagliero E., Murphy-Sheehy P., Singer DE, Nathan DM, Meigs JB Comparison of hyperglycemia, hypertension, and hypercholesterolemia management in patients with type 2 diabetes. Am J Med 2002;112:603-09.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Smith NL, Savage PJ, Heckbert SR et al. Glucose, blood pressure, and lipid control in older people with and without diabetes mellitus: the Cardiovascular Health Study. J Am Geriatr Soc 2002;50:416-23.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Colhoun HM, Betteridge DJ, Durrington PN et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS). Lancet 2004;364: 685-96.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Heart Protection Study Collaborative Group. Lancet 2002;360:7-22.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Baigent C., Keech A., Kearney PM et al. On behalf of the Cholesterol Treatment Trialists' (CTT) collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005;366:1267-78.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. N Engl J Med 1998;339:1349-57.[Abstract/Free Full Text]
  • Downs JR, Clearfield M., Weis S. et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA 1998;279:1615-22.[Abstract/Free Full Text]
  • Goldberg RB, Mellies MJ, Sacks FM et al. Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: subgroup analyses in the cholesterol and recurrent events (CARE) trial. The Care Investigators. Circulation 1998;98:2513-19.[Abstract/Free Full Text]
  • Keech A., Colquhoun D., Baker J. et al. Benefits of long term cholesterol lowering therapy using pravastatin among patients with diabetes in the ing therapy using pravastatin among patients with diabetes in the lipid study [abstract]. Aust N Z J Med 2000;30:172.
  • Haffner SM, Alexander CM, Cook TJ et al. Reduced coronary events in simvastatin-treated patients with coronary heart disease and diabetes or impaired fasting glucose levels: subgroup analyses in the Scandinavian Simvastatin Survival Study. Arch Intern Med 1999;159:2661-7.[Abstract/Free Full Text]
  • Centers for Disease Control and Prevention. National diabetes fact sheet. Available at www.cdc.gov/diabetes/pubs/general.htm. Accessed 28 Apr 2006.
  • A desktop guide to type 2 diabetes mellitus: European Diabetes Policy Group 1999. Diabet Med 1999;16:716-30.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97.[Free Full Text]
  • Grundy SM, Cleeman JI, Merz CN et al. Coordinating Committee of the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004;110:227-39.[Abstract/Free Full Text]
  • LaRosa JC, Grundy SM, Waters DD et al. Treating to New Targets (TNT) Investigators. Treating to New Targets (TNT) Investigators. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005;352:1425-35.[Abstract/Free Full Text]
  • Shepherd J., Barter P., Carmena R. et al. for the Treating to New Targets Investigators Effect of Lowering LDL Cholesterol Substantially Below Currently Recommended Levels in Patients With Coronary Heart Disease and Diabetes: The Treating to New Targets (TNT) study. Diabetes Care 2006;29:1220-6.[Abstract/Free Full Text]
  • Pederson TR, Faergeman O., Kastelein JJP et al. for the Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) Study Group. High-dose atorvastatin vs. usual-dose simvastatin for secondary prevention after myocardial infarction. The IDEAL Study: A Randomized Controlled Trial. JAMA 2005;294:2437-45.[Abstract/Free Full Text]
  • Birjmohun RS, Hutten BA, Kastelein JJP, Stroes ESG. Efficacy and safety of high-density lipoprotein cholesterol-increasing compounds: A meta-analysis of randomized controlled trials. J Am Coll Cardiol 2005;45:185-97.[Abstract/Free Full Text]
  • The FIELD Study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 2005;366:1849-61.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Rubins HB, Robins SJ, Collins D. et al. for the Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. N Engl J Med 1999;341:410-18.[Abstract/Free Full Text]
  • Rubins HB, Robins SJ, Collins D. et al. Diabetes, plasma insulin, and cardiovascular disease: subgroup analysis from the Department of Veterans Affairs high-density lipoprotein intervention trial (VA-HIT). Arch Intern Med 2002;162:2597-604.[Abstract/Free Full Text]
  • Robins SJ, Collins D., Wittes JT et al. for the VA-HIT Study Group. Relation of gemfibrozil treatment and lipid levels with major coronary events: VA-HIT: A randomized controlled trial. JAMA 2001;285:1585-91.[Abstract/Free Full Text]
  • Barter PJ, Rye KA Cardioprotective properties of fibrates: Which fibrate, which patients, what mechanism? Circulation 2006;113:1553-5.[Free Full Text]
  • Taylor AJ, Sullenberger LE, Lee HY ARBITER 3: Atherosclerosis regression during open-label continuation of extended-release niacin following ARBITER 2. Circulation 2005;112:II-179(Abstract 943).
  • The Coronary Drug Project Research Group. Clofibrate and niacin in coronary heart disease. JAMA 1975;231:360-81.[Abstract/Free Full Text]
  • Canner PL, Berge KG, Wenger NK et al. for the Coronary Drug Project Research Group. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. J Am Coll Cardiol 1986;8:1245-55.[Abstract]
  • Canner PL, Furberg CK, Terrin ML, McGovern ME Benefits of niacin by glycemic status in patients with healed myocardial infarction (from the Coronary Drug Project). Am J Cardiol 2005;95:254-7.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Kane JP, Malloy MJ, Ports TA et al. Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimens. JAMA 1990;264:3007-12.[Abstract/Free Full Text]
  • Blankenhorn DH, Nessim SA, Johnson RL, Sanmarco ME, Azen SP, Cashin-Hemphill L. Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts. JAMA 1987;257:3233-40.[Abstract/Free Full Text]
  • Brown G., Albers JJ, Fisher LD et al. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med 1990;323:1289-98.[Abstract]
  • Brown BG, Zhao XQ, Chait A. et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. Engl J Med 2001;345:1583-92.[Abstract/Free Full Text]
  • Morse JS, Brown BG, Zhao X-Q. et al. Niacin plus simvastatin protect against atherosclerosis progression and clinical events in CAD patients with low HDLc and diabetes mellitus or impaired fasting glucose [abstract 842-3]. J Am Coll Cardiol 2001;37(suppl A):262A.
  • Elam MB, Hunninghake DB, Davis KB et al. for the ADMIT Investigators. Effect of niacin on lipid and lipoprotein levels and glycemic control in patients with diabetes and peripheral arterial disease. The ADMIT study: a randomized trial. JAMA 2000;284:1263-70.[Abstract/Free Full Text]
  • Grundy SM, Vega GL, McGovern ME et al. for the Diabetes Multicenter Research Group. Efficacy, safety, and tolerability of once-daily niacin for the treatment of dyslipidemia associated with type 2 diabetes: results of the Assessment of Diabetes Control and Evaluation of the Efficacy of Niaspan Trial. Arch Intern Med 2002;162:1568-76.[Abstract/Free Full Text]
  • Zhao X.-Q, Morse JS, Dowdy AA et al. Safety and tolerability of simvastatin plus niacin in patients with coronary artery disease and low high-density lipoprotein cholesterol (The HDL Atherosclerosis Treatment Study). Am J Cardiol 2004;93:307-12.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • American Diabetes Association. Dyslipidemia management in adults with diabetes. Diabetes Care 2004;27(suppl 1):S68-S71.[CrossRef][Medline] [Order article via Infotrieve]
  • Oberwittler H., Baccara-Dinet M. Clinical evidence for use of acetyl salicylic acid in control of flushing related to nicotinic acid treatment. Int J Clin Pract 2006;60:707-15.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]

The British Journal of Diabetes & Vascular Disease, Vol. 7, No. 1, 25-30 (2007)
DOI: 10.1177/14746514070070010501
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This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
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Services
Right arrow Email this article to a friend
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Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Reasner, C.
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Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?