Coronary disease, dyslipidaemia and clinical trials in type 2 diabetes mellitus

Epidemiological data testify that dyslipidaemia is a major risk factor for coronary disease in type 2 diabetes mellitus. Post hoc analyses of the subgroup of diabetic patients in the large lipid-regulating trials suggest that increasing plasma HDL-cholesterol in association with a major fall in LDL-cholesterol with a statin, or increasing HDL-cholesterol together with a major fall in triglyceride with a fibrate, decreases the incidence of coronary events. The absolute risk reduction appears to be sufficiently high to make lipid-regulating therapy in these patients cost-effective. Correction of dyslipidaemia is therefore likely to play a major role in preventing and reversing macrovascular disease in diabetes, but this needs to be tested prospectively. This demand is being met by on-going trials of lipid-regulating therapy in type 2 diabetes and these are accordingly reviewed. Their results should establish a more rigorous approach to the detection and treatment of diabetic dyslipidaemia, which at present should, in general, follow guidelines recommended by the ADA and other expert bodies. The management of diabetic dyslipidaemia in particular needs to be considered within the context of modification of multiple co-existent cardiovascular risk factors. Besides lipid-regulation, there are several new therapies that warrant testing in future clinical trials of the prevention and reversal of coronary disease in diabetes.