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Intensive lipid‐lowering strategy in patients with diabetes mellitus
Author(s) -
Kanters S. D. J. M.,
Algra A.,
De Bruin T. W. A.,
Erkelens D. W.,
Banga J. D.
Publication year - 1999
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1046/j.1464-5491.1999.00080.x
Subject(s) - medicine , diabetes mellitus , intensive care medicine , endocrinology
Summary Aims To assess the feasibility of an intensive lipid‐lowering strategy in diabetic subjects pursuing target plasma lipid levels. Methods Patients with diabetes mellitus (DM), Type 1 or 2, with plasma lipid levels exceeding target values (LDL‐cholesterol < 2.6 mmol/l, triglycerides < 1.7 mmol/l, HDL‐cholesterol > 0.9 mmol/l for men and > 1.1 mmol/l for women) were eligible. After 6–12 weeks of diet and glycaemic control, lipid‐lowering medication (simvastatin/gemfibrozil/acipimox) was prescribed in steps of incremental dosages and combinations for 30 weeks. Results Of all eligible clinic patients, 25% initially responded and finally 12% were entered. Thirty‐six patients with Type 1 and 59 with Type 2 DM were studied. Mean baseline lipid levels in Type 1 and Type 2 diabetic subjects were: LDL‐cholesterol 3.6 and 3.7 mmol/l, triglycerides 1.7 and 2.2 mmol/l, HDL‐cholesterol for men 1.1 and 1.0 mmol/l, and for women 1.4 and 1.2 mmol/l, respectively. All three target values were reached in 66% of the patients. LDL‐cholesterol was reduced by 1.2 mmol/l in Type 1 and 1.3 mmol/l in Type 2 diabetic patients and triglycerides by 0.7 mmol/l and 1.1 mmol/l, respectively. HDL‐cholesterol increased by 0.15 mmol/l and 0.34 mmol/l in men and women with Type 1 diabetes mellitus, respectively. The cholesterol–triglyceride ratio decreased significantly in VLDL in Type 1 diabetes and in IDL in Type 2 diabetes and increased significantly in HDL in Type 2 DM. Conclusions A minority of subjects eligible for intensive lipid lowering agreed to participate in a feasibility study, suggesting a potentially large compliance problem for a general lipid‐lowering programme in a diabetes clinic. Nevertheless , intensive lipid lowering with drug combinations can attain the recommended target lipid levels in 66% of subjects with diabetes. With this strategy the plasma lipoprotein composition shifts towards a less atherogenic profile. Subjects with diabetes should therefore receive lipid‐lowering therapy tailored to reach target levels, rather than standard dosages, in order to reduce atherogenic risk.