Reducing coronary heart disease associated with type 2 diabetes: lifestyle intervention and treatment of dyslipidaemia.
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.
Tuomilehto
Jaakko
J
Diabetes and Genetic Epidemiology Unit, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland. jaakko.tuomilehto@ktl.fi
D001835:Body Weight; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000378:metabolism / Q000517:prevention & control; D004359:Drug Therapy, Combination; D011345:Fenofibrate / Q000627:therapeutic use; D005464:Fluorobenzenes / Q000627:therapeutic use; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000628:therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008019:Life Style; D008687:Metformin / Q000627:therapeutic use; D009043:Motor Activity; D011743:Pyrimidines / Q000627:therapeutic use; D000068718:Rosuvastatin Calcium; D013449:Sulfonamides / Q000627:therapeutic use
D005464:Fluorobenzenes; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D011743:Pyrimidines; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D008687:Metformin; D011345:Fenofibrate