Key result
Fibrate-statin combination addresses residual CV risk in T2D patients with atherogenic dyslipidemia.
Why the study?
Despite LDL cholesterol reduction with statins, substantial residual cardiovascular risk remains in type 2 diabetes patients driven by atherogenic dyslipidemia, motivating evaluation of intensive combination lipid treatments.
Combination therapy with a statin and fibrate may address residual cardiovascular risk in type 2 diabetes patients with atherogenic dyslipidemia.
Supports statin-fibrate combination for residual risk in T2D atherogenic dyslipidemia; leaves open dedicated outcome trials before practice change.
Despite best treatment efforts reducing low-density lipoprotein cholesterol, a substantial number of type 2 diabetes mellitus patients still experience progression of cardiovascular risk. Even with intensification of statin therapy, a substantial residual cardiovascular risk remains and atherogenic dyslipidemia is an important driver of this so-called residual risk. Besides statin therapy, new strategies evaluate the role of intensive combination lipid treatment for the entire type 2 diabetic population. The results from the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Lipid trial suggest that there is a lipid-related modifiable component to cardiovascular residual risk in statin-treated type 2 diabetic patients, and that further research should address patients with triglycerides above 204 mg/dl and high-density lipoprotein cholesterol below 34 mg/dl. Based on their respective lipid-modifying activity, the combination of a fibrate and statin is a logical approach to improving achievement of lipid targets in statin-treated patients with a glomerular filtration rate of >60 ml/min/1.73 m(2) and with residual atherogenic dyslipidemia. The link between dyslipidemia treatment and diabetic retinopathy, nephropathy and neuropathy is an emerging new field and microvascular complications are targets for new treatments.
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Wanner et al. (2011) conducted a review in Type 2 Diabetes Mellitus with Atherogenic Dyslipidemia. Combination lipid treatment (fibrate and statin) was evaluated. Combination therapy with a fibrate and statin is a logical approach to address residual cardiovascular risk in statin-treated patients with type 2 diabetes and atherogenic dyslipidemia.
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