Combination Cholesterol Drugs Better Than One for Diabetics

Combination therapy with statin and fibrate is better than treatment with
either drug alone for treating mixed dyslipidemia in patients with type 2
diabetes.
Mixed dyslipidemia is a condition in which an individual has several lipid
irregularities, such as high LDLs (the "bad" cholesterol) and low HDLs (the
"good" cholesterol) and high triglycerides (a cardiovascular disease risk
factor.)
Simvastatin, belongs to a popular drug class referred to as "statins, while
fenofibrate, works through a different mechanism. When combined together,
the treatment effectively returned lipid levels back to normal levels.
"I believe every diabetic should be initially treated with a statin, with an
LDL goal of at least 100 and probably even 70 would be better," Dr. Joseph
Brent Muhlestein told. "I secondarily also look at triglycerides and HDL. I
then target additional lipid therapy based on which of these three lipid
values remain the most off-goal."
Muhlestein from the Intermountain Medical Center and LDS Hospital, Salt Lake
City, Utah, and associates investigated the effects of simvastatin alone,
fenofibrate alone, and the combination of simvastatin and fenofibrate on
lipid components in 498 patients with type 2 diabetes without coronary heart
disease.
Combination therapy reduced very low density lipoprotein cholesterol
significantly more than did fenofibrate or simvastatin monotherapy, the
investigators found. Simvastatin lowered intermediate density lipoprotein
cholesterol significantly more than did fenofibrate.
The percentage of LDL cholesterol pattern B constituting total LDL
cholesterol was significantly reduced by fenofibrate (a 13.7 percent
reduction) and by the combination (an 11.1 percent reduction), but not by
simvastatin.
LDL cholesterol pattern B is characterized by small, dense LDL molecules
that are more likely to lead to atherosclerosis and heart disease.
Combination therapy plus fenofibrate shifted LDL cholesterol pattern B to a
more buoyant LDL cholesterol that was less inclined to form plaques on the
walls of the arteries that lead to arthrosclerosis, they note in the
American Journal of Cardiology.
"Diabetic dyslipidemia appears to be a very important contributor to the
overall cardiovascular risk associated with diabetes," Muhlestein concluded.
"This risk comes from the combination of elevated LDL, elevated
triglycerides, and low HDL. Aggressive treatment of this mixed dyslipidemia
may be very important in saving the lives of our diabetic patients." [Am J
of Cardio]