Appropriate First-Line Lipid-Lowering Therapy for Type 1 Diabetes Mellitus—Reply

In reply

We thank Dr Ansell for his interest in our work and for his comments. We agree with him and with the guidelines recommended by the ADA¹ and other medical organizations, that management of dyslipidemia in patients with diabetes needs to be considered in the context of multiple coexisting cardiovascular risk factors. Regarding patients with dyslipidemia, available data show that intervention benefits these patients and that, because of the high cardiovascular risk and mortality in this population, aggressive intervention is warranted. Based on post hoc analysis of the subgroup of patients with diabetes in large lipid-lowering trials, there is now ample evidence^2- 3 that the management of plasma lipids to reduce coronary risk should take low-density lipoprotein cholesterol as well as high-density lipoprotein cholesterol and triglyceride levels into account, as recommended by the ADA. However, while the target levels for low-density lipoprotein and high-density lipoprotein cholesterol are consistent with trial results, the target level for plasma triglycerides (<195 mg/dL [2.2 mmol/L]) may be too conservative¹ if we consider that the mean triglyceride concentrations obtained in trials with statins and fibrates were around 133 mg/dL (1.5 mmol/dL) and 80 mg/dL (0.9 mmol/L), respectively.^2- 4 Thus, the goal for triglyceride treatment will probably need to be revised in the future.