Management of dyslipidemia in people with type 2 diabetes mellitus

Cardiovascular disease is a major complication of type 2 diabetes mellitus, and this is partly due to associated abnormalities of plasma lipid and lipoprotein metabolism. Although glycemic control improves plasma lipoprotein abnormalities and may have an independent benefit on cardiovascular risk reduction, the magnitude of this benefit is less than cholesterol lowering therapy. Current treatment guidelines for the management of dyslipidemia in people with type 2 diabetes are based on the results of cardiovascular outcome clinical trials. Primary emphasis of treatment should be on lowering LDL-C to < 100 mg/dl with statins. If cardiovascular disease is present, then high dose statins should be used, and an optional LDL-C goal < 70 is recommended. If triglycerides are > 200 mg/dl, then a secondary goal is to lower non-HDL-C < 130 mg/dl (< 100 mg/dl if cardiovascular disease is present) is recommended. Low HDL-C levels are common in type 2 diabetes but are not currently recommended as a target for treatment because of the lack of definitive cardiovascular outcome studies supporting this goal, and because of the difficulty in raising HDL-C. The additional benefit of combination therapy with fibrates, ezetimibe or niacin added to a statin on cardiovascular risk is uncertain pending the results of on-going cardiovascular outcome studies.