Davidson Michael H
Chicago Center for Clinical Research, Rush-Presbyterian-St. Luke's Medical Center, 1725 West Harrison Street, Suite 1159, Chicago, IL 60612, USA.
Curr Diab Rep. 2003 Jun;3(3):263-8. doi: 10.1007/s11892-003-0074-1.
Owing to the National Cholesterol Education Program Adult Treatment Panel III recommendations that patients with diabetes require a low-density lipoprotein (LDL) less than 100 mg/dL and a non-high-density lipoprotein (HDL) less than 130 mg/dL, frequently, combination lipid-lowering therapy is required. However, diabetic patients are commonly on multiple medications and have renal impairment. Therefore, the risk of myopathy with statin therapy is markedly increased. The safety of lipid-lowering therapy can be significantly improved by avoiding high-dose statins in combination with fibrates, especially gemfibrozil. To achieve non-HDL goals combining fenofibrate, or if glucose is well controlled, niacin, with a statin (not to exceed 40 mg), may significantly reduce the risk of myopathy. For diabetic patients who require additional LDL lowering, ezetimibe may provide a safe combination to a statin to achieve the LDL goal of less than 100 mg/dL.
由于美国国家胆固醇教育计划成人治疗小组第三次报告建议，糖尿病患者的低密度脂蛋白（LDL）应低于100mg/dL，非高密度脂蛋白（HDL）应低于130mg/dL，因此常常需要联合降脂治疗。然而，糖尿病患者通常服用多种药物且存在肾功能损害。所以，他汀类药物治疗引起肌病的风险显著增加。通过避免大剂量他汀类药物与贝特类药物（尤其是吉非贝齐）联合使用，可显著提高降脂治疗的安全性。为实现非HDL目标，将非诺贝特，或者如果血糖控制良好则将烟酸与他汀类药物（不超过40mg）联合使用，可能会显著降低肌病风险。对于需要进一步降低LDL的糖尿病患者，依泽替米贝与他汀类药物联合使用可能是安全的，可实现LDL低于100mg/dL的目标。
