Lipid-lowering trials in diabetes

Type 2 diabetes is increasingly recognized as a major risk factor for coronary heart disease (CHD). The recent Adult Treatment Panel III of the National Cholesterol Education Program makes special mention of diabetes and the metabolic syndrome and proposes a secondary goal of therapy following achievement of the LDL goal, namely non-HDL cholesterol (the sum of VLDL and LDL cholesterol, i.e. total cholesterol-HDL cholesterol). In addition diabetes is recognized as a CHD risk equivalent. Much information is available from subgroup analysis of the major CHD secondary prevention trials of lipid-lowering with regard to the benefits for diabetic patients. However little information is available from clinical trials in primary prevention. Ongoing trials will help fill this gap. Recently the first report of a large lipid-lowering trial addressing coronary atherosclerosis in a specific diabetic population has been published-the Diabetes Atherosclerosis Intervention Study (DAIS). In this study fenofibrate therapy was associated with reduced progression of coronary atherosclerosis assessed by quantitative coronary angiography.