Lipids, lipid-lowering therapy and diabetes complications

Abstract

Cardiovascular disease (CVD) remains the primary cause of morbidity and mortality in patients with diabetes. Lipid-lowering therapy (LLT) is often required, and statin drugs are usually the first-line therapy. However, even when LDL-cholesterol values are within the target range, a substantial residual risk persists. Fibrates may help to lower this risk, especially in patients with high triglyceride and low HDL-cholesterol levels, as suggested by the lipid ACCORD trial. Furthermore, they may even have beneficial effects on the development of microvascular complications such as nephropathy and especially retinopathy, as suggested by the results of the FIELD study. Data suggest benefit with fenofibrate on diabetic retinopathy, with significant effects on the requirement for first laser treatment and macular oedema. Fibrates, like statins, may act directly to decrease the progression of diabetic complications through their lipid-lowering effects, but may also go beyond that via pleiotropic effects. Recent data and the possible underlying mechanisms are analyzed in this review.