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Expert Review

Cardiovascular Disease: Expert Review and Commentary from Published Literature

Diabetes 2013

Bringing Patients with Type 2 Diabetes to LDL-C Goals

Robert A. Hegele, MD, FRCPC, FACP, FAHA, FCAHS
Martha G. Blackburn Chair in Cardiovascular Research and Canada Research Chair
Robarts Research Institute, University of Western Ontario, London, Ontario

Reiterated in the 2013 Canadian Diabetes Association (CDA) guidelines, the primary goal for low-density lipoprotein cholesterol (LDL-C) in patients with type 2 diabetes mellitus (T2DM) is ≤2.0 mmol/L.(1) Even though LDL-C levels are often only modestly elevated in T2DM patients,(2) the same strict LDL-C target applies as in other high-risk patients without T2DM, including those who have had a previous cardiovascular event.(3) In patients with T2DM, the first-line therapy for reaching LDL-C goals is typically an HMG CoA reductase inhibitor (statin). The second-line agents, used adjunctively, or in the case of intolerance, as a substitutefor statins, are listed in the CDA guidelines alphabetically as bile acid sequestrants, a cholesterol absorption inhibitor, fibrates and nicotinic acid formulations. Each second-line drug has its own particular benefits and shortcomings. The second-line lipid-modifying agents may help patients with T2DM reach LDL-C targets, but their use should be individualized based on the anticipated benefit derived from their specific therapeutic profiles.

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