A 63-year-old woman with Type 2 diabetes is seen for follow-up after a fasting lipid profile. She has no other medical conditions and feels well. Her diabetes is well controlled and the last hemoglobin A1C value was 6.5%. Her total cholesterol (T-chol) is 240 mg/dL, HDL50 mg/dL, low-density lipoprotein (LDL) 160 mg/dL, and triglycerides 150 mg/dL.For the above patient with dyslipidemia, select the most appropriate treatment.
Patients with diabetes have the same rates of coronary heart disease events as patients with established CAD. Therefore, diabetes is now considered a coronary heart disease equivalent when assessing risk even if the patient has not had any previous cardiac symptoms. The current guidelines support risk reduction efforts (both lifestyle and drug therapy) in patients with diabetes similar to those recommended for patients with CAD (secondary prevention). The goal for LDL is < 100 mg/dL in patients with diabetes and secondary goals include considering fibrates for those with high triglycerides and nicotinic acid for low HDL cholesterol. Lifestyle modification is recommended for everyone irrespective of risk.
fibric acid derivatives (clofibrate, gemfibrozil)
nicotinic acid
bile acid-binding resins (cholestyramine, colestipol)
hepatic hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (lovastatin, simvastatin, pravastatin)
C.V.S.