Treating dyslipidaemia in non-insulin-dependent diabetes mellitus - a special reference to statins

Patients with non-insulin-dependent diabetes (NIDDM) have an increased inci dence of ischaemic heart disease (IHD) when compared with nondiabetic subje cts. In addition, they have a worse prognosis after their first myocardial infarction (MI). According to the recent USA recommendations. the thr thres hold for initiation of dietary intervention in diabetic subjects is an LDL greater than 2.6 mmol/l, with the goal to achieve levels less than 2.6 mmol /l (100 mg/dl). This is also the threshold for initiation and treatment goa l for pharmacological intervention in diabetic subjects, unless they are co mpletely free of IHD, peripheral vascular disease or cerebrovascular diseas e and have no other IHD risk factors. In the latter circumstances, the thre shold for treatment is an LDL greater than 3.38 mmol/l (130 mg/dl), with th e goal to achieve levels less than 3.38 mmol/l. The HMG-CoA reductast: inhi bitors (statins) can improve the lipid profile effectively and safely in NI DDM. Results from post hoc analyses of diabetic subgroups in the large inte rvention trials suggest that some statins significantly reduce the risk for IHD-related mortality/morbidity. However. because these results are derive d from secondary prevention trials, we cannot be sure if these benefits app ly to all diabetic subjects or only to those who already have IHD. Neverthe less, it seems logical to assume: that this benefit also applies to NIDDM p atients who do not have IHD because they share a similar vascular risk as n ondiabetic subjects who have IHD. Intervention trials using statins and fib rates, alone or in combination. in NIDDM are under way. In a few years thes e trials will provide definitive end-point-based evidence in this high-risk group of patients. (C) 2001 Elsevier Science Inc. All rights reserved.