Treatment of dyslipidemia in patients with type 2 diabetes: Overview and meta-analysis of randomized trials

Abstract 

Dyslipidemia in type 2 diabetes is characterized by high plasma triglyceride and decreased HDL cholesterol levels, as well as by predominance of small, dense LDL particles. Furthermore, the majority of patients with diabetes have higher than recommended LDL cholesterol levels. Several clinical randomized trials reviewed in this article shown benefit of statin treatment in primary and secondary prevention in patients with diabetes.

We performed a meta-analysis of six secondary prevention trials with statins. Overall, a significant reduction in major coronary events (death from coronary artery disease or non-fatal myocardial infarction) by 22% was observed in these studies. Meta-analysis of four studies, which included patients without previous cardiovascular disease, shown also highly significant 32% reduction in the rate of major coronary events. Significant benefit of statin treatment was showed also in the meta-analysis of four trials, in which LDL cholesterol of ≤2.0mmol/l was achieved in actively or aggressively treated group.

Evidence-base from the studies with fibrates is less conclusive, since it comes from subgroup analysis of two trials, which included higher number of patients with diabetes. In both trials final triglyceride level of ≤1.5mmol/l was achieved.

Based on the above-mentioned evidence, all patients with diabetes should be treated with statins to achieve LDL cholesterol level ≤2.0mmol/l. A secondary goal of triglyceride level ≤1.5mmol/l is also reasonable to achieve. Achieving of both goals may warrant combination of statin treatment with fibrate, ezetimibe or niacin. However, results of no endpoint study with lipid lowering combination treatment have been published thus far.

Keywords: Dyslipidemia, Type 2 diabetes, Statin, Fibrate, Meta-analysis of trials