A. Characteristics
Dyslipidemia is common in diabetics and is characterized by borderline (200–400 mg/dl; 2.3–4.5 mmol/L) to moder¬ate elevations of triglyceride levels greater than 400 mg/dl (see Fig. 4). There is also an increase in total cholesterol levels to greater than 240 mg/dl with increased levels of small, dense LDL cholesterol (bad cholesterol) of greater than 160 mg/dl. Another characteristic of dyslipidemia is a low level of HDL cholesterol less than 35 mg/dl (0.9 mmol/L).
B. Management of Dyslipidemia
1. Statin Drugs
The management of this deleterious manifestation of dia¬betes is crucial, because cardiac events and deaths can be prevented. Patients with elevated LDL cholesterol (220– 300 mg/dl), mild elevation of triglycerides (<300 mg/dl), and lowered HDL (<35 mg/dl) are best managed with atorvastatin or rosuvastatin, because these agents are some¬what more effective than other statins in increasing HDL levels, decreasing triglycerides, and is a powerful reducer of LDL cholesterol. Other statins include simvastatin and pravastatin. These statins do not significantly reduce triglycerides and have little effect on HDL cholesterol.
2. Fibrates
Fibric acid derivatives called fibrates are useful when the LDL cholesterol levels are mildly elevated (110–140 mg/dl) and triglycerides are very high (>500 mg/dl; 5 mmol/L)and particularly when the HDL levels are very low (>0.8 mmol/L). The combination of a statin and fibrate may cause muscle damage that is associated with marked elevations of creatinine kinase in the blood. Damage to muscle or myositis may be reversible but can be extensive enough to damage to the filtration system of the kidney and cause kidney failure. This drug combina¬tion is recommended by diabetologists and used in diabetic and lipid clinics, but the author believes that this strategy is not justifiable because the combination has caused kidney failure and deaths worldwide, albeit rarely, and the FDA has not approved the combination.

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