Department of Endocrinology, Diabetology, Nutrition, Jean-Verdier Hospital, AP-HP, CRNH-IdF, Paris Nord University, Bondy, France.
Diabetes Metab. 2011 Feb;37(1):15-24. doi: 10.1016/j.diabet.2010.10.001. Epub 2010 Dec 3.
Cardiovascular disease (CVD) remains the primary cause of morbidity and mortality in patients with diabetes. Lipid-lowering therapy (LLT) is often required, and statin drugs are usually the first-line therapy. However, even when LDL-cholesterol values are within the target range, a substantial residual risk persists. Fibrates may help to lower this risk, especially in patients with high triglyceride and low HDL-cholesterol levels, as suggested by the lipid ACCORD trial. Furthermore, they may even have beneficial effects on the development of microvascular complications such as nephropathy and especially retinopathy, as suggested by the results of the FIELD study. Data suggest benefit with fenofibrate on diabetic retinopathy, with significant effects on the requirement for first laser treatment and macular oedema. Fibrates, like statins, may act directly to decrease the progression of diabetic complications through their lipid-lowering effects, but may also go beyond that via pleiotropic effects. Recent data and the possible underlying mechanisms are analyzed in this review.
心血管疾病（CVD）仍然是糖尿病患者发病率和死亡率的主要原因。通常需要降脂治疗（LLT），他汀类药物通常是一线治疗药物。然而，即使 LDL-胆固醇值在目标范围内，仍然存在很大的残余风险。正如脂质 ACCORD 试验所表明的那样，贝特类药物可能有助于降低这种风险，特别是在甘油三酯和 HDL-胆固醇水平高的患者中。此外，正如 FIELD 研究的结果所示，它们甚至可能对微血管并发症的发展（如肾病，尤其是视网膜病变）产生有益的影响。数据表明，非诺贝特对糖尿病视网膜病变有益，对首次激光治疗和黄斑水肿的需求有显著影响。贝特类药物与他汀类药物一样，可能通过其降脂作用直接作用于降低糖尿病并发症的进展，但也可能通过多效性作用超越这一点。在这篇综述中分析了最近的数据和可能的潜在机制。
