Statins and beyond: concurrent strategies for prevention of cardiovascular disease in patients with type 2 diabetes.

Diabetes is a significant risk factor for the development of cardiovascular disease (CVD), particularly in the presence of high blood pressure, poor glycaemic control and high total cholesterol. While efforts to control blood pressure or blood glucose beyond levels considered 'normal' in patients with diabetes have not produced the expected reduction in CVD, treatment with statins to reduce levels of low-density lipoprotein cholesterol (LDL-C) has been much more successful. However, many patients with diabetes who receive statins (even at high doses) remain at significant residual risk of CVD due to the presence of atherogenic dyslipidaemia. Markers of persisting risk include low levels of high-density lipoprotein cholesterol (HDL-C), high levels of triglycerides (TG) and LDL-C levels above target despite high-dose statin therapy. Combining statins with drugs that target HDL-C and TG, such as fibrates, niacin and omega-3 polyunsaturated fatty acid (PUFA) ethyl esters, may offer further protection from CVD in patients with diabetes.