Téma: Clinical pharmacology

Evidence-based treatment of dyslipidemia in type 2 diabetes mellitus and metabolic syndrome with fibrates

Ivan Tkáč

Atherogenic dyslipidemia of metabolic syndrome (DLPMS) affects the majority of patients with the metabolic syndrome (MS) or type 2 diabetes mellitus (DM2). It is characterized by both increased triglyceride (TG) and decreased HDL cholesterol (HDLC) level, as well as by the predominance of small, dense LDL particles. Based on the mechanism of action fibrates appear as suitable drugs for treatment of this type of dyslipidemia. Performed angiographic studies LOCAT and DAIS showed slower progression of coronary atherosclerosis with fibrate treatment. Current clinical guidelines were based mainly on posthoc analyses of endpoint studies with gemfibrozil (VA-HIT) and bezafibrate (BIP), which showed reduction in cardiovascular and cerebrovascular morbidity in subgroups of patients with type 2 diabetes and MS. Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study was the first randomized trial, which focused primarily on patients with type 2 diabetes. 9 795 patients were included in the study a randomized for treatment with micronized fenofibrate or placebo. The median follow-up was 5 years. Treatment with fenofibrate led to a significant reduction in incidence of non-fatal myocardial infarction by 24 %. In subgroup of diabetic patients without previous cardiovascular disease a significant reduction of all cardiovascular endpoints by 19 % was observed. Based on the results of above-mentioned studies fibrates are indicated in the treatment of those patients with type 2 diabetes or metabolic syndrome, whose LDL cholesterol levels are lower than recommended, either spontanousely or after statin treatment. Fibrates could be first choice drugs in patients with high triglyceride level > 4,5 mmol/l. Target triglyceride level modification to < 1,5 mmol/l is recommended based on the above-mentioned studies.

Ročník 2005  Témy časopisu Internal medicine 12 / 2005

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