title: The ACCORD-Lipid study: implications for treatment of dyslipidemia in Type 2 diabetes mellitus.
abstract: Patients with Type 2 diabetes mellitus (T2DM) are at high risk of developing cardiovascular disease (CVD). Treatment of diabetic dyslipidemia, comprised mainly of hypertriglyceridemia, and low HDL-C, with either statin or fibrate monotherapy, is moderately effective at reversing the abnormal lipid levels, but does not completely reverse the risk of CVD. Combination therapy with a statin and fibrate more effectively treats diabetic dyslipidemia; however, neither the impact on CVD risk nor the safety profile of statin-fibrate combined treatment had been tested in a large randomized trial. The Action to Control Cardiovascular Risk in Diabetes (ACCORD)-Lipid trial tested the hypothesis that combination therapy with a fibrate and statin would more effectively prevent major CVD events in a high-risk population of patients with T2DM compared with statin monotherapy. In ACCORD-Lipid, over 5000 patients were treated with fenofibrate plus simvastatin versus simvastatin alone. Although combination therapy did not significantly reduce CVD event rates in the ACCORD-Lipid cohort as a whole, a predefined subgroup of participants with the combination of significant hypertriglyceridemia and low HDL-C experienced a 31% lower event rate with combination therapy.Post hocanalyses conducted in similar subsets in previous fibrate monotherapy trials were concordant with these findings in ACCORD-Lipid. Combination therapy was well tolerated and safe, with no detectable increase in myopathy. The implications of the ACCORD-Lipid findings for the treatment of dyslipidemia in patients with T2DM are discussed.
authors.affiliation: Section of Epidemiology, Department of Public Health Sciences, Wake Forest University - School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157-1063, USA.
authors.forename: Marshall
authors.initials: M
authors.lastname: Elam
authors.affiliation: Section of Epidemiology, Department of Public Health Sciences, Wake Forest University - School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157-1063, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Lovato
authors.affiliation: Department of Medicine, College of Physicians & Surgeons of Columbia University, PH-10-305, 630 West 168th Street, New York, NY 10032, USA.
authors.forename: Henry
authors.initials: H
authors.lastname: Ginsberg
keywords: HDL-C; coronary heart disease; diabetes; dyslipidemia; fenofibrate; simvastatin; stroke; triglyceride