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Two Lipid Drugs May Be Better Than One

Tara Dairman

March 28, 2008

A new study has found that combining two different types of drugs—a statin and a fibrate—to treat abnormal lipid levels may be better than using just one drug for people with Type 2 diabetes.

The study, which was published in February in The American Journal of Cardiology, looked at 300 people with Type 2 diabetes and “mixed dyslipedemia,” but no history of heart disease. Mixed dyslipedemia was defined as having at least two of the following irregularities in blood lipid levels: high LDL (”bad”) cholesterol (100 mg/dl or more); high triglycerides (200 mg/dl or more); and low HDL (”good”) cholesterol (less than 40 mg/dl).

The study’s participants were randomly assigned to take a statin alone (20 mg of simvastatin), a fibrate alone (160 mg of fenofibrate), or both. After 12 weeks of drug therapy, the researchers assessed people’s levels of various lipid subparticles that are markers for cardiovascular disease risk. They found that combination therapy showed the most benefit overall, lowering markers such as dense very low-density lipoprotein (VLDL) cholesterol and small, dense LDL cholesterol molecules. The combination therapy was especially effective in people with triglyceride levels over 170 mg/dl. It was also effective at raising HDL cholesterol.

The combination of drugs may have been more successful because the two drugs work to control lipid levels by different mechanisms. However, the study was short and only looked at risk markers, not at the actual development of cardiovascular disease. More information about how these two drugs affect the actual development of cardiovascular disease should be available when the lipid-treatment arm of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial ends in 2009.

This study received funding from Abbott Laboratories, Inc., and materials from Merck & Company, Inc. Brand-name simvastatin (Zocor) is manufactured by Merck, and brand-name fenofibrate (TriCor) is manufactured by Abbott, though generic versions of both drugs are also available.



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