Treating Abnormal Lipids

Lifestyle changes, possibly medications required to bring you back to middle ground.

By Merle Myerson, MD.

Many people with diabetes are also treated for abnormal lipids – either their LDL cholesterol or triglycerides are too high, or their HDL (the "good" cholesterol) is too low. Your health care provider will measure your lipids when you are fasting. Goals for LDL cholesterol are < 100 mg/dL, but may be even lower (< 70 mg/dL) if you have many other risk factors; have had cardiovascular disease (coronary artery disease, cerebrovascular disease, stroke, or peripheral vascular disease); or smoke cigarettes. Goals for HDL cholesterol are > 40 mg/dL for men and > 50 mg/dL for women. The goal for triglycerides is < 150 mg/dL.

Ask your health care provider for a copy of your blood test results so you can keep track of your lipids. Mark down what medications you are taking at the time of each blood test and any other relevant notes such as weight gain or loss; increase or decrease in exercise; or change in your diet. These can all impact your lipid numbers in addition to the medications you may be taking.

A treatment program to bring your lipids to goal will include a review of lifestyle factors and proper medications.

Treatment via Lifestyle

While lifestyle modifications may not eliminate the need for medications, they can help reduce the amount you may need and help your overall cardiovascular health. Lifestyle goals can be:

  • physical activity and regular aerobic exercise
  • maintaining a good body weight
  • eating a heart healthy diet

Treatment via Medication

Many, if not most people with diabetes, will also require medications. The statin drugs, considered standard of care (American Diabetes Association, "Standards of Medical Care in Diabetes – 2010), are:

  • atorvastatin (Lipitor)
  • fluvastatin (Lescol)
  • lovastatin (Mevacor)
  • pitavastatin (Livalo)
  • pravastatin (Pravachol)
  • rosuvastatin (Crestor)
  • simvastatin (Zocor)

In addition to lowering LDL and triglycerides, and raising HDL, the statin drugs improve the integrity of your arteries, reduce inflammation, and decrease platelet aggregation. While all statins work by the same mechanism (they block a key enzyme in your body's synthesis of cholesterol), there are differences among them in terms of interactions with other medications, potency, and tendency for side effects.

People with diabetes often have elevated triglycerides and may be prescribed a medication more specific to treat this. A group of drugs called "fibrates" are often used and these include gemfibrozil (Lopid), fenofibrate (Tricor, Lofibra), and fenofibric acid (Trilipix). When used in combination with statin drugs, it is important to check for side effects, including muscle soreness and possible elevations in liver enzymes. Another drug that may be used to treat high triglycerides is omega-fatty acids, which are derived from fish oil. There is a prescription formulation (Lovaza), but non-prescription supplements can be taken as well. Omega-3 fatty acids have very minimal side effects.

If LDL cholesterol is still not at goal with a statin, other medications may be added. These include a cholesterol absorption inhibitor - ezetimibe (Zetia) - that blocks the intestinal absorption of cholesterol or another class of medications called bile acid sequestrants; examples being cholestyramine (Questran); or a newer formulation, colesevelam (Welchol). These medications do not work in the body, but act to prevent absorption of cholesterol and remove it from the body as waste. An added benefit of colesevelam is improvement in glycemic control in adults with type 2 diabetes. Caution is needed when combined with other medications as these drugs may prevent their absorption; this is usually managed by keeping doses of each medicine four or more hours apart. Niacin is another medication that can help lower LDL cholesterol and triglycerides as well as increase HDL cholesterol. It is available in several forms, both short-acting and extended release (Niaspan). Niacin may slightly worsen glucose control.

Read Dr. Myerson's bio here.

Read more of Dr. Myerson's columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

Last Modified Date: March 01, 2013

All content on dLife.com is created and reviewed in compliance with our editorial policy.

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