Current Lipid-lowering Strategies for the Treatment of Diabetic Dyslipidemia: An Integrated Approach to Therapy

Diabetes mellitus is a metabolic disease that is associated with high rates of cardiovascular mortality. Therapeutic strategies available for treatment of diabetes involve modification of cardiovascular risk factors by dietary changes, tight control of blood glucose, pharmacological lowering of plasma lipids, and reduction of elevated blood pressure. In this review, the role of hypolipidemic agents in treating diabetic patients is addressed. Included are findings from clinical studies that have evaluated the efficacy and safety of various classes of hypolipidemic agents, alone or in combination, in the treatment of diabetic dyslipidemia. Statins are a major class of hypolipidemic agents that effectively reduce total cholesterol and low-density lipoprotein cholesterol (LDL-C) and plasma triglycerides, while increasing high-density lipoprotein cholesterol (HDL-C) levels. Fibrates are another important class of lipid altering drugs that lower plasma triglycerides, increase HDL-C, and favorable modify LDL-C particle composition. Niacin and nicotinic acid analogs lower total cholesterol, LDL-C, and triglycerides, while increasing HDL-C. However, niacin therapy may or may not be associated with decreased glucose control. Conventional bile acid sequestrants, although effective in decreasing total cholesterol and LDL-C, can increase triglycerides under certain circumstances. Various combinations of these agents seem to be highly effective at allowing diabetic patients to achieve lipid-lowering goals. Furthermore, new hypolipidemic agents, such as colesevelam hydrochloride, can be used alone or in combination therapy and may offer physicians therapeutic alternatives, particularly for diabetic patients who cannot tolerate higher dosage levels of systemic agents yet require further reductions to reach plasma cholesterol target levels. Integration of a complete therapeutic strategy targeted to achieve specific reduced levels of LDL, including effective and safe lipid-lowering drugs for treatment of dyslipidemia in people with diabetes, will likely reduce the risk and burden of cardiovascular disease in these patients.