Reducing coronary heart disease associated with type 2 diabetes: lifestyle intervention and treatment of dyslipidaemia

Abstract 

Efforts to reduce the burden of coronary heart disease (CHD) associated with type 2 diabetes should include increased emphasis on preventing progression to diabetes in individuals with impaired glucose tolerance. Recent large-scale studies have shown that lifestyle intervention can reduce progression to diabetes by nearly 60%. Dyslipidaemia is a risk factor for CHD in diabetic patients. Accumulation of evidence indicating significant reductions in CHD risk with statin treatment to lower low-density lipoprotein (LDL)–cholesterol has led to the recommendation that reduction of LDL-cholesterol be considered the highest priority in treating diabetic dyslipidaemia; additional aims of treatment include raising high-density lipoprotein (HDL)–cholesterol and reducing triglyceride levels. In a recent trial of rosuvastatin alone or combined with fenofibrate in diabetic patients with combined hyperlipidaemia, rosuvastatin 40 mg monotherapy produced marked beneficial changes in LDL-cholesterol (−47%), HDL-cholesterol (+6%) and triglycerides (−30%), with the combination of lower-dose rosuvastatin (10 mg) and fenofibrate producing a significantly greater triglyceride reduction (−47%) and comparable changes in other lipid measures. Combination therapies for dyslipidaemia may be the key to optimizing CHD risk reduction in type 2 diabetes.

Keywords: Diabetes, Coronary heart disease, Dyslipdaemia, Statin treatment, LDL-cholesterol