Cardiovascular risk and lipid-lowering drug therapy

Patients with type 2 and advanced type 1 diabetes bear a very high risk for cardiovascular disease, which is substantially driven by the associated dyslipidemia; therefore, patients with diabetes clearly benefit from intensive lipid-lowering therapy. To ensure optimal risk reduction, lipid-lowering therapy must consistently aim at and achieve the recommended target values. Statins reduce low-density lipoproteins (LDL) and non-high-density lipoprotein (HDL) cholesterol and are the mainstay of lipid-lowering therapy also in diabetes patients but highly potent statins are often applied to reach the goals. Ezetimib and bile acid sequestrants also lower cholesterol levels and may be given in combination with statins or to statin-intolerant patients. Fibrates effectively lower serum triglycerides and provide clinical benefits in patients with concurrent low HDL cholesterol levels. Nicotinic acid and long-chain omega 3 fatty acids could provide improvements due to HDL cholesterol elevation, anti-arrhythmic and other effects.