Evaluating the Options in Correcting Dyslipidemia

Charles A. Reasner, MD.

Disclosures
In This Article

ADA Guidelines

Because diabetic patients with even mildly elevated serum lipids are at risk for development of CAD, and because lipid-lowering therapy can substantially reduce the risk of cardiac events in the diabetic population, the American Diabetes Association (ADA) has recommended guidelines for acceptable lipid levels in patients with diabetes.[3] As listed in Table 2, the ADA assigned category of risk based on lipoprotein levels in adults with diabetes. These categories form the foundation of target lipid levels for diabetic patients: LDL-C less than 100 mg/dL, HDL-C greater than 45 mg/dL, and a triglyceride level less than 200 mg/dL.

Table 3 indicates when medical nutrition therapy and pharmacologic therapy should be prescribed, and Table 4 lists the specific treatment approaches for adult diabetics, as recommended in the ADA guidelines. Medical nutrition therapy should be prescribed for all diabetic patients with an LDL-C level higher than 100 mg/dL. Pharmacologic therapy should be instituted for diabetic patients with risk factors (CHD, peripheral vascular disease, CVD) whose LDL level is higher than 100 mg/dL. Lipid lowering for patients with diabetes without evidence of CVD should be initiated at an LDL level of 130 mg/dL, but patients with multiple risk factors may be started on pharmacologic therapy at levels between 100 mg/dL and 130 mg/dL.[3] Tight control of glycemia and administration of a statin should be regarded as first-line therapy for lipid abnormalities in patients with type 2 diabetes. The statin class of drugs lowers LDL-C and at high levels may modestly reduce triglycerides, alleviating the need for combination therapy in patients with both elevated LDL-C and triglycerides.[3]

Now that the CARE trial has demonstrated the impact of IFG on cardiac events, we may in the future see data that suggest the need for aggressive treatment of dyslipidemia in patients with any form of insulin resistance.

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