Management of special type of dyslipidemia; Low HDL-C, high TG, Type- B size LDL-P in patients with T2DM is a big challenge for a physician. For primary LDL-C goal, we the physician usually go for stronger statins like atorvastatin or rosuvastatin. Addition of fenofibrate to the above statins to reduce concomitant high TG really reduces TG level but does such combination offer any strong role in reducing mortality in this population [1]? To increase HDL-C, trials with CETP inhibitors like torcetrapib or anacetrapib failed to reduce CV mortality. Newer CETP inhibitor evacetrapib although leading to increase HDL-C but cardiovascular protection is still under question [2]. We were using extended release nicotinic acid along with statin (ARBITER 6 -HALTS trial) but my practice did not show any significant benefit. Recently, after premature halting of AIM-HIGH trial, efficacy of nicotinic acid also became under question and even increased events of ischemic stroke in this population leading me to change my treatment strategy. Currently no safe drug to increase HDL-C is available. More ever, drug induced increased HDL has no CV benefit. Lifestyle modification is still remaining the best strategy along with statin and if necessary, n-3 to manage dyslipidemia in patients with diabetes and other high risk population.

Ref: 1. Hyperlipidaemia and cardiovascular disease: do fibrates have a role? Current Opinion in Lipidology: August 2011 - Volume 22 - Issue 4 - p 270-276 doi: 10.1097/MOL.0b013e32834701c3 2. Effects of the CETP Inhibitor Evacetrapib Administered as Monotherapy or in Combination With Statins on HDL and LDL Cholesterol. JAMA.2011;306(19):2099-2109. doi:10.1001/jama.2011.1649

Conflict of Interest:

None declared