Intensive lipid-lowering strategy in patients with diabetes mellitus

Aims To assess the feasibility of an intensive lipid-lowering strategy in d iabetic subjects pursuing target plasma lipid levels. Methods Patients with diabetes mellitus (DM), Type 1 or 2, with plasma lipi d levels exceeding target values (LDL-cholesterol <2.6mmol/l, triglyceridcs <1.7mmol/l, HDL-cholesterol > 0.9 mmol/l for men and > 1.1 mmol/l for wome n) were eligible. After 6-12 weeks of diet and glycaemic control, lipid-low ering medication (simvastatin/gemfibrozil/acipimox) was prescribed in steps of incremental dosages and combinations for 30 weeks. Results Of all eligible clinic patients, 25% initially responded and finall y 12% were entered. Thirty-six patients with Type 1 and 59 with Type 2 DM w ere studied. Mean baseline lipid levels in Type 1 and Type 2 diabetic subje cts were: LDL-cholesterol 3.6 and 3.7 mmol/l, triglycerides 1.7 and 2.2 mmo l/l, HDL-cholesterol for men 1.1 and 1.0 mmol/l, and for women 1.4 and 1.2 mmol/l, respectively. All three target values were reached in 66% of the pa tients. LDL-cholesterol was reduced by 1.2 mmol/l in Type 1 and 1.3 mmol/l in Type 2 diabetic patients and triglycerides by 0.7 mmol/l and 1.1 mmol/l, respectively. HDL-cholesterol increased by 0.15 mmol/l and 0.34 mmol/l in men and women with Type 1 diabetes mellitus, respectively. The cholesterol- triglyceride ratio decreased significantly in VLDL in Type 1 diabetes and i n IDL in Type 2 diabetes and increased significantly in HDL in Type 2 DM. Conclusions A minority of subjects eligible for intensive lipid lowering ag reed to participate in a feasibility study, suggesting a potentially large compliance problem for a general lipid-lowering programme in a diabetes cli nic. Nevertheless, intensive lipid lowering with drug combinations can atta in the recommended target lipid levels in 66% of subjects with diabetes. Wi th this strategy the plasma lipoprotein composition shifts towards a less a therogenic profile. Subjects with diabetes should therefore receive lipid-l owering therapy tailored to reach target levels, rather than standard dosag es, in order to reduce atherogenic risk.