Does treating hyperlipidaemia with medication prevent complications?

There is now good evidence supporting the efficacy and safety of currently available drugs for lowering low-density lipoprotein cholesterol (LDL-C) in the prevention of cardiovascular disease (CVD) in patients with diabetes, particularly with statin therapy. Almost all patients with type 2 diabetes who can tolerate the medication warrant such therapy. The extent to which lowering triglycerides and raising HDL-C with currently available drugs reduces CVD risk remains less clear. Trials of fibrates in patients with diabetes and established CVD have given conflicting results. In patients without CVD, lowering LDL-C with a statin seems more efficacious than focusing on triglycerides and HDL-C with a fibrate. The effect of sole therapy with niacin on CVD risk in diabetes is untested. Trials are under way to provide an evidence base for some important outstanding questions, in particular the role of combination therapy (statin plus fibrate, statin plus niacin, statin plus ezetimibe) in patients at goal for LDL-C and the efficacy of lipid lowering in advanced renal diseas