Atherosclerotic disease in non-insulin-dependent diabetes mellitus: Role of abnormal lipids and the place for lipid-altering therapies
Type 2 diabetes confers a markedly increased risk for atherosclerotic vascular disease. This risk is mediated in part by the plasma lipid and lipoprotein abnormalities that result from insulin resistance and by the broad disorder of energy metabolism of type 2 diabetes. While it is clear that intensive insulin therapy and, to some extent, therapy with oral agents can ameliorate diabetic dyslipidemia, data are lacking on the impact of glucose control on cardiovascular disease risk in patients with this condition. By contrast, data are emerging that suggest a role for lipid- altering therapy in patients with type 2 diabetes, with at least 1 trial (4S) showing that active statin treatment has a greater effect on end point reduction in the subgroup with diabetes than it has in the nondiabetic group. Although other large trials have also suggested that the benefit of lipid- altering drugs in persons with diabetes is similar to the benefit in persons without diabetes, data from studies designed prospectively to examine the impact of lipid-lowering therapy on clinical end points are lacking. A number of planned and ongoing trials will begin to address this issue. These studies, which are using both statins and fibrates, may yield information that permits a more effective targeting of specific lipid-altering therapies than has yet been possible; they may also establish more specific goals of treatment.
Orloff, DG; Blazing, MA; O'Connor, CM
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