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Can J Diabetes 37 (2013) S324

Canadian Journal of Diabetesjournal homepage:

www.canadianjournalofdiabetes.com

Executive Summary

Dyslipidemia

3. In patients achieving goal LDL-C with statin therapy, the routine additionof fibrates or niacin for the sole purpose of further reducing CV risk shouldnot be used [Grade A, Level 1 (4,5)].

4. For individuals not at LDL-C target despite statin therapy, a combination ofstatin therapy with second-line agents may be used to achieve the LDL-Cgoal [Grade D, Consensus].

5. For those who have serum TG >10.0 mmol/L, a fibrate should be used to

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KEY MESSAGES

� The beneficial effects of lowering low-density lipoprotein cholesterol(LDL-C) with statin therapy apply equally well to people with diabetes as tothose without the disease.

� The primary treatment goal for people with diabetes is LDL-C�2.0 mmol/L,which is generally achievable with statin monotherapy.

� Achievement of the primary goal may require intensification of lifestylechanges and/or statin therapy and, on occasion, the addition of other lipid-lowering medications.

reduce the risk of pancreatitis (Grade D, Consensus) while also optimizingglycemic control and implementing lifestyle interventions (e.g. weightloss, optimal dietary strategies, reduction of alcohol).

Abbreviations:Apo B, apolipoprotein B; CV, cardiovascular; HDL-C, high-density lipopro-tein cholesterol; LDL-C, low-density lipoprotein cholesterol; TC, totalcholesterol; TG, triglyceride.

Highlights of Revisions

� The chapter provides a more precise definition of people who should receivestatin therapy as per the Vascular Protection chapter, (p. S322).

� The total cholesterol to high density lipoprotein (TC/HDL) ratio as a target hasbeen eliminated, as has the option to start a statin or fibrate in those withtriglycerides 4.5 to 10.0 mmol/L.

� A new recommendation to not add fibrate or niacin routinely to statin therapyfor cardiovascular risk reduction has been added.

RECOMMENDATIONS

1. A fasting (8-hour fast) lipid profile (TC, HDL-C, TG, and calculated LDL-C) ornonfasting lipid profile (apo B, noneHDL-C calculation) should bemeasuredat the timeofdiagnosisofdiabetes. If lipid-loweringtreatment isnot initiated(see Vascular Protection chapter. p. S322. for indications), repeat testing isrecommended yearly. More frequent testing (every 3e6 months) should beperformedafter treatment fordyslipidemia is initiated [GradeD, Consensus].

2. For patients with indications for lipid-lowering therapy (see VascularProtection chapter, p. S322), treatment should be initiated with a statin[Grade A, Level 1 (1,2)] to achieve LDL-C�2.0mmol/L [Grade C, Level 3 (3)].

99-2671/$ e see front matter � 2013 Canadian Diabetes Associationp://dx.doi.org/10.1016/j.jcjd.2013.02.024

References

1. Collins R, Armitage J, Parish S, et al, Heart Protection Study Collaborative Group.MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in5963 people with diabetes: a randomised placebo-controlled trial. Lancet 2003;361:2005e16.

2. Colhoun HM, Betteridge DJ, Durrington PN, et al, CARDS Investigators. Primaryprevention of cardiovascular disease with atorvastatin in type 2 diabetes in theCollaborative Atorvastatin Diabetes Study (CARDS): multicentre randomisedplacebo-controlled trial. Lancet 2004;364:685e96.

3. Cholesterol Treatment Trialists’ (CTT) Collaborators, Kearney PM, Blackwell L,Collins R, et al. Efficacy of cholesterol-lowering therapy in 18,686 people withdiabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008;371:117e25.

4. The ACCORD Study Group. Effects of combination lipid therapy in type 2 dia-betes mellitus. N Engl J Med 2010;362:1563e74.

5. The AIM-HIGH Investigators. The role of niacin in raising high-density lipopro-tein cholesterol to reduce cardiovascular events in patients with atheroscleroticcardiovascular disease and optimally treated low-density lipoprotein choles-terol: rationale and study design. The Atherothrombosis Intervention in Meta-bolic syndrome with low HDL/high triglycerides: Impact on Global Healthoutcomes (AIM-HIGH). Am Heart J 2011;161:471e7.