The fats of life in diabetes

Abstract

Dyslipidaemia is a feature of diabetes and a risk factor for future cardiovascular disease (CVD) though the exact relationships for lipid fractions differ between type 1 and type 2 diabetes. CVD risk equivalence is a well established concept for easy prioritisation of treatment of patients with diabetes as a group but masks a wide range of CVD risk within the group depending on type of diabetes, its duration, the extent of microvascular disease and presence of other risk factors. The first line treatment for CVD risk in diabetes is the use of statins though reduction in non-high-density lipoprotein cholesterol may be a better indicator of efficacy of treatment than low-density lipoprotein cholesterol. The status of all second line therapies for dyslipidaemia in diabetes is unclear as though fibrates and niacin have monotherapy evidence, in general CVD trials to date do not show clear benefits of combination therapy. Multiple novel medications for dyslipidaemia are in development but all require specific investigations in patients with diabetes and also endpoint trials before they can be accepted into general use.