Furthermore, the guidelines open the way to initiating statins essentially independent of the LDL cholesterol in patients considered to be at high or very high risk, with the NCEP report setting an optional goal of 70 mg/dl in the latter group of individuals. People with type 2 diabetes, ages 40 to 75, should start moderate-intensity statin therapy if they have LDL levels of 70 mg/dL or greater. Children do not need to count grams of saturated fat. Its important to have healthy levels of both HDL and LDL. Lipids Health Dis. (2021). It is also clear that achievement of all three lipid goals is more likely with statin plus fibrate or statin plus niacin combinations.30-32However, the added complexity and risks of combination therapy in the absence of persuasive clinical trial evidence for additional CVD benefit must place some limitations on the use of these combinations. For example, people who have gone through menopause may have higher LDL and lower HDL cholesterol levels. 2018 AHA/ACC Multisociety guideline on the management of blood cholesterol. The ATP III recognizes the increasing number of studies correlating elevated triglyceride levels with increased coronary artery disease risk. There are no clinical trials evaluating the effect of combination therapy on clinical cardiovascular outcomes. What is considered high cholesterol? The beneficial effect of simvastatin was similar in diabetic subjects with LDL > and < 116 mg/dl. If you are worried about your child's weight, consider consulting with a registered dietitian or expressing your concerns with your pediatrician. 2014 Nov 14;9(11):e112715. Once LDL levels are within normal range, a patient's lipoprotein profile should be monitored every six to 12 months. 2018;10(4):281-289. doi:10.14740/jocmr3362w. PLoS One. Recent studies have shown that the identification and treatment of dyslipidemia in patients 65 years and older can decrease the risk of first and recurrent coronary events. The prevalence of QTc prolongation was not significantly different across gender (p = 0.135).Patients with prolonged QTc interval were significantly older (p = 0.001), had higher BMI (p = 0.030), longer diabetes duration (p = 0.050), and lower total cholesterol The NCEP and the ADA concur in reducing the intake of saturated and trans-saturated fatty acids to lower LDL cholesterol levels.7,23The NCEP ATP III recommends limiting the intake of saturated fat to < 7% of daily calories and limiting the intake of cholesterol to < 200 mg per day. Your risk factors also determine how often your cholesterol should be checked. PyoralaK,Pedersen TR, Kjekshus J, Faergeman O, Olsson AG, Thorgeirsson G: Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease: a subgroup analysis of the Scandinavian Simvastatin Survival Study (4S). In those without evident CVD, it would seem appropriate for patients above the age of 40 years or with another major CVD risk factor,such as hypertension. The HPS included 5,963 diabetic individuals, 2,912 of whom had no known CVD. This distinction was primarily made to delineate the establishment of new target LDL levels for patients with CHD and to provide appropriate therapy to these patients based on their increased cardiovascular risk. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. There are few noticeable symptoms of high cholesterol. Triglyceride reduction is a secondary benefit of statins (the primary benefit being LDL cholesterol reduction). Raises persons with diabetes but without CHD to the risk level of CHD risk equivalent, Uses Framingham projections of 10-year absolute CHD risk to identify patients with multiple (2 or more) risk factors for more intensive treatment, Identifies persons with metabolic syndrome as candidates for intensified therapeutic lifestyle changes, Optimal LDL cholesterol level is now <100 mg per dL (2.60 mmol per L), Increases categorical low HDL cholesterol level to <40 mg per dL (1.05 mmol per L), Lowers triglyceride classification cut points, Recommends complete lipoprotein profile (total, LDL, HDL, triglycerides) as preferred screening for assessing CHD risk status, Encourages use of plant sterols/stanols as a therapeutic dietary option to lower LDL cholesterol levels, Presents strategies for adherence to therapeutic lifestyle changes and drug therapies, Recommends treatment beyond LDL lowering for triglyceride levels >200 mg per dL (2.26 mmol per L), One diet recommended for the entire population, 12-week trial of diet alone before adding pharmacotherapy, Low HDL cholesterol (<40 mg per dL [1.05 mmol per L]), Hypertension (blood pressure >140/90 mm Hg or taking antihypertensive medication). There was no significant difference in the gender distribution of the study population. When using combination therapy, patients should be advised to promptly report unexplained muscle complaints. Cholesterol levels in children and adolescents. The establishment of diabetes as a CHD risk equivalent reflects the prevalence of heart disease as a cause of death in the diabetic population. High levels of triglycerides and low levels of HDL raise your risk for heart disease. Type 2 diabetes is associated with a marked increased risk of cardiovascular disease (CVD). WebWith type 2 diabetes, your body doesnt regulate or use glucose ( sugar) the way it should. J Clin Diagn Res. Plant based diets are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all-cause mortality in general population of middle aged adults. Grundy SM, et al. The higher your HDL, the better. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. Current guidelines recommend that all children have their cholesterol checked between ages 9 and 11 years, and then again between ages 17 and 21 years. According to the 2000 American Diabetes Association Guidelines, the primary goal of hyperlipidemia therapy in patients with type 2 diabetes (with or without vascular Medication may be indicated in children is if your child has inherited a genetic disorder called familial hypercholesterolemia. This article reviews the data concerning diabetic dyslipidemia and its The American Heart Association (AHA) suggests that a statin is the most effective means of lowering LDL cholesterol levels. There are many different types of medication for cholesterol. The An improvement of cardiovascular risk factors by omega-3 polyunsaturated fatty acids. VLDL levels can be monitored as part of the lipoprotein profile, and respond similarly to the lifestyle changes and to the medicines used to treat triglyceride levels. Patients who stop smoking can expect an increase of up to 30 percent in their HDL levels.16, As indicated by ATP III, failure of TLC to modify LDL cholesterol levels or the presence of high CHD risk levels warrants the use of drug therapy. High glucose levels can LDL cholesterol was the strongest independent predictor of CHD followed by HDL cholesterol,6supporting current national guidelines in which LDL lowering is the primary lipid target. If you don't have prexisting CVD, your numbers should be: total cholesterol: 45 mg/dL LDL cholesterol (the "bad" cholesterol): 35 mg/dL LDL cholesterol: < 100 mg/dL Current Guidelines: New Focus on Statins The ADA now recommends that all people with diabetes take the cholesterol lowering drugsstatinsin addition to lifestyle Other medications used to bring down LDL levels include: For individuals with specific risk factors for cardiovascular disease, the AHA and American College of Cardiology have specific guidelines for when cholesterol levels should trigger the use of statins or other cholesterol-lowering medications. The mean baseline total cholesterol and triglyceride values were 250 and 177 mg/dl, respectively. The primary treatment strategy, as in the NCEP guidelines, is LDL cholesterol lowering to < 100 mg/dl. You can make swaps such as using olive oil or avocado oil instead of butter. WebThe goal is to get less than 10% of ones calories from saturated fat. The prevalence of QTc prolongation was not significantly different across gender (p = 0.135).Patients with prolonged QTc interval were significantly older (p = 0.001), had higher BMI (p = 0.030), longer diabetes duration (p = 0.050), and lower total cholesterol The recent Heart and Estrogen/progestin Replacement Study (HERS) has cast some doubt on the use of hormone replacement therapy (HRT) in the secondary prevention of CHD risk in postmenopausal women.9 Although several primary prevention studies support the use of HRT to prevent heart disease, the studies that support the use of statins to prevent heart disease in women are much stronger. This is why it's important to get your cholesterol levels checked. Barbie Cervoni MS, RD, CDCES, CDN, is a registered dietitian andcertified diabetes care and education specialist. (2018). Erratum: Good to Know: Understanding Your A1C Test. This will vary based on factors like other medications you may be taking, your age, sex, and general health. Rather, reducing your intake can make a big impact on your cholesterol levels. Most would argue that individuals with type 2 diabetes and another risk factor are at high risk of cardiovascular events. Healthline Media does not provide medical advice, diagnosis, or treatment. Click to explore. Finally, ongoing clinical trials in specific diabetic populations evaluating the effect of fibrates alone (the Fenofibrate Intervention and Event Lowering in Diabetes Study) or in combination with statin (the Action to Control Cardiovascular Risk in Diabetes Study) may provide some evidence for more specific recommendations for the management of diabetic dyslipidemia. Despite its use, particular attention to TLC should always be maintained and reinforced by the physician. High Risk 2 or more risk factors and risk score 10-20% II. Cholesterol levels: What you need to know. Ideally, HDL cholesterol should be above 40 mg/dL for males and above 50 mg/dL for females. To establish that the product manufacturers addressed safety and efficacy standards, we: We do the research so you can find trusted products for your health and wellness. Read our, Prescription Drugs for Cholesterol and Triglycerides. Click to explore. The ADA recommends that most adults with diabetes aim for the following blood sugar goals:Fasting: Less than 100 mg/dLPreprandial (before meals): 70-130 mg/dLPostprandial (one to two hours after eating): Less than 180 mg/dLBedtime: 100-140 mg/dL It should be no more than 100 mg/dL, or even 70mg/dL, if you have any of those conditions or high total cholesterol. Current guidelines call for an aggressive treatment strategy to reduce LDL cholesterol, blood pressure, and glucose levels in diabetic patients, but data concerning the management of high triglyceride (TG) levels and low HDL cholesterol levels remains inconclusive. However, evidence for a beneficial effect arising from the addition of niacin therapy to statin treatment was suggested by the HDL Atherosclerosis Treatment Study.22 In this trial, the effect of combination therapy with simvastatin and niacin compared with placebo on angiographic end points was evaluated in 160 (16% with diabetes) individuals with prior CHD and low HDL cholesterol levels. Treatment with 40 mg of simvastatin reduced the risk of major CHD by 27%. For patients with low HDL cholesterol (<40 mg/dL), consider interventions to raise HDL It helps make cells and performs other functions involving vitamins and hormones. That can lead to too-high levels of glucose in your blood. WebGale Academic OneFile includes Adherence to statin therapy and LDL cholesterol goal at by Elizabeth S. Parris, David B. Lawrence,. Is there a goal LDL level for people with diabetes? For individuals with LDL cholesterol levels between 100 and 129 mg/dl, both sets of guidelines now support statin therapy to achieve at least a 30-40% LDL cholesterol reduction. How much physical activity do adults need? Poor glycemic control has repeatedly been shown to be associated with an elevated risk of cardiovascular events. doi:10.1371/journal.pone.0112715, Wing RR, Lang W, Wadden TA, et al. In the ATP III guidelines, the target LDL level for patients with established CHD is still 100 mg per dL or less. Table 34 outlines LDL cholesterol goals and cut points for initiation of TLC and prescription medication. WebThe A1C goal for most adults with diabetes is between 7% and 8%, but your goal may be different depending on your age, other health conditions, medicines youre taking, and other factors. The fenofibrate group showed significantly less angiographic progression than the placebo group. In 1988, the National Cholesterol Education Program, Adult Treatment Panel I (NCEPATP I) developed its first set of guidelines, establishing clear goals for patients with lipid abnormalities. The main goal of cholesterol-lowering treatment is to lower your LDL level enough to reduce your risk Click here to learn more. Children should have their cholesterol checked at least once between the ages of 9 and 11 and again between 17 and 20 years Adults who have a history of high cholesterol, heart disease, diabetes, or obesity need more frequent readings, as do all adults as they age. WebA normal A1C level is below 5.7%, a level of 5.7% to 6.4% indicates prediabetes, and a level of 6.5% or more indicates diabetes. MyPlate: Fruits. Managing High Cholesterol When You Have Diabetes, What to Know About High Cholesterol and COVID-19. High cholesterol. (n.d.). (2020). How Much Cholesterol Should I Be Having Each Day to Be Healthy? Having too much LDL cholesterol can put you at greater risk of heart attack or stroke. Patients with diabetes were more likely to be women and to have less education. An improvement of cardiovascular risk factors by omega-3 polyunsaturated fatty acids. Improving glycemic control in individuals with moderate to severe hyperglycemia regardless of type of treatment is associated with improvement in lipid values. Patients diagnosed with diabetes (N=998,790) between 2015 and 2019 were evaluated for CKD risk on the basis of achieving treatment goals. By demonstrating cardiovascular event reduction through the use of statins, the 4S, CARE, and AFCAPS/TexCAPS trials support cholesterol-lowering therapy in women. The change in HDL was the only lipid measure that predicted the CVD benefit. Total cholesterol also includes a triglyceride count. The American Diabetes Association (ADA) has set desirable LDL cholesterol,HDL cholesterol, and triglyceride levels as < 100, > 40 in men/> 50 in women, Normal cholesterol levels vary by age. HDL cholesterol. Two major modalities for lowering the LDL level advocated by the ATP III are therapeutic lifestyle changes (TLC) and drug therapy. SeverPS, Dahlof B, Poulter Wedel H, Beevers G, Caulfield M, Collins R, Kjeldsen SE,Kristinsson A, McInnes GT, Mehlsen J, Nieminen M, O'Brien E, Ostergren J, for the ASCOT investigators: Reduction in cardiovascular events with atorvastatin in 2,532 patients with type 2 diabetes. This provides a more reliable indicator of heart health than looking at the total cholesterol or LDL figures. Total cholesterol <4.0 mmol/L Initiation of pharmacotherapy is dependent on the assessment of absolute Cholesterol is an important topic for heart health. Recommended total cholesterol levels are under 200 milligrams per deciliter (mg/dL) for most adults and under 170 mg/dL for children. Clin Diabetes 1 January 2006; 24 (1): 2732. As we age, cholesterol levels tend to climb. You need some cholesterol to build healthy cells, but an accumulation of the bad kind can be problematic, increasing the risk of atherosclerosis (clogged arteries). The AHA recommends quitting smoking and avoiding secondhand smoke to improve cholesterol. [Evidence level A, RCTs/meta-analyses] This was not consistently true across the spectrum of baseline triglyceride levels, suggesting that HDL was the primary element responsible for the positive outcome. The Diabetes Atherosclerosis Intervention Study,19 an angiographic trial conducted only in diabetic individuals, tested the effect of fenofibrate compared with placebo on angiographic end points in 418 individuals with type 2 diabetes and dyslipidemia. We explain just how much cholesterol you should have each day and where fats fit in. Women typically need One tablespoon of butter contains about 7 grams of saturated fat, more than half of the recommended daily allowance. If you have a history of atherosclerosis, your LDL should Yogurt and Cholesterol: What You Need to Know, Heart Disease: How ApoB Cholesterol Tests Can More Accurately Identify Risks, Treatments, Ideal is 60 or higher; 40 or higher for men and 50 or higher for women is acceptable, Less than 100; below 70 if coronary artery disease is present, less than 40 for men and less than 50 for women, Less than 75 in children 09; less than 90 in children 1019, 7599 in children 09; 90129 in children 1019, 100 or more in children 09; 130 or more in children 1019. Other risk factors such as cigarette smoking, hypertension, diabetes, and a low level of high-density lipoprotein (HDL) cholesterol also have been implicated in CHD.3. Support for the use of fibrates in individuals with dyslipidemia comes from the Veterans Affairs Cooperative Studies Program High-Density Lipoprotein Cholesterol Intervention Trial,18 in which 2,531 men (25% with diabetes) with CHD and low HDL cholesterol and without high LDL cholesterol values (mean LDL cholesterol 108 mg/dl) were randomized to gemfibrozil 1,200 mg daily or placebo. Dietary therapy remains the first line of treatment, with drug therapy reserved for use in patients at high risk for CHD or patients who do not respond to nonpharmacologic therapy. How much physical activity do children need. This is not to say that fibrates and niacin, the two agents most commonly recommended for HDL raising, do not have value in treatment of dyslipidemia. Medical options for people with familial hypercholesterolemia. PalumboPJ:Metformin: effects on cardiovascular risk factors in patients with non-insulin-dependent diabetes mellitus. Barbie Cervoni MS, RD, CDCES, CDN, is a registered dietitian andcertified diabetes care and education specialist. The majority of these subjects have very high risk, and an LDL-C goal of <70 mg/dL is recommended. In May 2001, the National Cholesterol Education Program released its third set of guidelines, reflecting changes in cholesterol management since their previous report in 1993. Maintain a healthy weight: Carrying too much weight in the abdomen can increase the risk of heart disease and is associated with increased LDL. There are two types of cholesterol: LDL and HDL. ColhounHM,Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, Thomason MJ,Mackness MI, Charlton-Menys V, Fuller JH: Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomized placebo-controlled trial. Cholesterol levels tend to rise with age, so the recommended ranges for your cholesterol will depend on your age. The American Heart Association (AHA) recommends that adults reduce saturated fat to less than 6% of total calorie intake. This article reviews 10 natural ways to increase HDL (good) cholesterol and lower LDL (bad) cholesterol. If that fails to bring LDL levels below 100 mg/dL and there are other cardiovascular risk factors present, the addition of ezetimibe to statin therapy should be considered. The AFCAPS/TexCAPS study correlated a 6 percent increase in HDL cholesterol levels with a reduction of first acute major coronary events in men and women with baseline average LDL cholesterol levels and below-average HDL cholesterol levels. In particular, insulin resistance has been found in persons with low levels of HDL cholesterol and high levels of very low-density lipoprotein (VLDL) cholesterol and triglycerides.20 Because insulin resistance is often a precursor to the development of this syndrome, identification and potential treatment of insulin-resistant patients has been suggested as a means of preventing some or all components of the syndrome. The strategy underlying the addition of a second or third agent is to optimize improvements in the lipid profile achieved by initial (usually statin) therapy. Heart Protection Study Collaborative Group: MCR/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomized placebo-controlled trial. Get your children involved in the cooking process, too. Both the ADA and the ESC suggest people with type 2 diabetes should aim for a low-density lipoprotein-cholesterol (LDL-C) level of less than 100 mg/dL. WebPeople with diabetes should keep their levels of cholesterol within a h ealthy range, which is often a lower level than most people. Effectiveness of low to moderate physical exercise training on the level of low-density lipoproteins: A systematic review. The decision to start medication will also depend on your medical history, age, weight, and if you have any other risk factors for heart disease, including high blood pressure and diabetes. Here is the adult range for HDL cholesterol: 1 A lower BP target of 130 mm Hg may be appropriate for certain individuals, such as younger patients, those with albuminuria, and those with one or more additional ASCVD risk factors. However, if you have an existing health condition and are not exercising regularly, you should consult your physician before starting an exercise program. When you can, make it a family affair by going for a bike ride, a walk, or participating in a family-friendly game of basketball, kickball, or tag. Total cholesterol. The defined goals were HbA 1c of less than 7%, SBP of less than 130 mm Hg, LDL-C of less than 100 mg/dL, non-high-density lipoprotein cholesterol (HDL-C) of less than 130 mg/dL, and BMI of 18.5 to 25. Research shows that eating more yogurt can help lower your cholesterol, but be mindful of what type you're eating. This doesn't mean that you can never eat these foods again. For some people, lifestyle changes can be enough to bring cholesterol levels into the healthy ra In addition to modifying current strategies of risk assessment, the new guidelines stress the importance of an aggressive therapeutic approach in the management of hypercholesterolemia. The two major cholesterol-carrying lipoproteins are low-density lipoprotein (LDL) and high-density lipoprotein (HDL): Since your total cholesterol level is a combination of your LDL cholesterol and your HDL cholesterol, ideally you want to keep your LDL levels low and your HDL levels high. Dyslipidemia is a common problem for people with diabetes. In addition, cyclophilins A, B, and C were significantly correlated with cardiovascular risk factors, but only cyclophilin B was associated with type 2 diabetes. Metabolic syndrome, or insulin resistance syndrome, is defined as a cluster of abnormalities that include obesity, hypertension, dyslipidemia, and type 2 diabetes; it is associated with insulin resistance and compensatory hyperinsulinemia.18 It is estimated that this syndrome affects 70 to 80 million Americans.19. Cholesterol is found in the foods you eat, but it is also made by the liver. LDL cholesterol is considered the bad type of cholesterol because it forms harmful plaques along the walls of your arteries. By then the plaque could already have built up, says Dr. Eugenia Gianos, director of cardiovascular prevention for Northwell Health in New York. Consider having fish twice per week and adding ground flax, nuts, or seeds to oats, pancakes, or smoothies for fiber and healthy fat. Sex and gender exist on spectrums. Simvastatin plus niacin resulted in a significant angiographic benefit. Prevention and treatment of high cholesterol: hyperlipidemia. Most people should try to keep their total cholesterol below 200 milligrams per deciliter (mg/dL), or 5.2 millimoles per liter (mmol/L). Our website services, content, and products are for informational purposes only. By lowering the acceptable triglyceride level from the previous set of guidelines, the ATP III encourages a more aggressive approach to hypertriglyceridemia (Table 7).4 Diet and exercise are the primary modes of treating hypertriglyceridemia. There are fewer studies using fibrates or niacin. The goals of alternative treatment for heart disease are often to control cholesterol levels, lower blood pressure, and improve heart health. The recommended LDL cholesterol level to start pharmacological therapy is > 100 mg/dl in individuals with established CHD and > 130 mg/dl in those without CHD. Integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Butter, salted. Use lower-fat cooking methods: Lower-fat cooking methods may also help to reduce cholesterol. Test Your High Cholesterol IQ: Are You at Risk for a Heart Attack? This content is owned by the AAFP. Van Rensburg W. (2019). Your cholesterol levels are affected by genetics, dietary choices, and lifestyle factors like: For some people, lifestyle changes can be enough to bring cholesterol levels into the healthy range, according to a 2019 study. Wing RR, et al. Men are generally at a higher risk than women for higher cholesterol. Thank you, {{form.email}}, for signing up. Final Recommendation Statement Lipid Disorders in Adults (Cholesterol, Dyslipidemia): Screening December 30, 2013 Recommendations made by the USPSTF are independent of the U.S. government. Generally, guidelines are similar for men and women over the age of 20, though they differ when it comes to HDL cholesterol, as seen above. According to the Centers for Disease Control and Prevention (CDC), having high cholesterol raises your risk for heart disease. Screening is still recommended for all patients 20 years or older and every five years thereafter. Here are 9, Forget HDL and LDL. According to the new guidelines, the number of patients with cholesterol levels that can be classified as abnormal has now tripled. Benefits of LDL-lowering therapy initially should be monitored at six-week intervals. Cardiovascular disease is the primary cause of death among American women, far exceeding the rate of all cancers combined.1 Women's mortality following myocardial infarction is three times that of men,8 suggesting that women may not be active participants in cardiovascular risk reduction strategies. Cholesterol has many important functions. The results of cholesterol tests can determine whether you need to start taking medications or adopt certain lifestyle changes to bring your cholesterol levels into a healthy range. PfefferMA, Keech A, Sacks FM Cobbe SM, Tonkin A, Byington RP, Davis BR, Friedman CP, Braunwald E: Safety and tolerability of pravastatin in long-term clinical trials:prospective Pravastatin Pooling Project (PPP). Although both agents increased HDL cholesterol and LDL cholesterol, pioglitazone was associated with a greater increase in HDL cholesterol and less LDL cholesterol increase than rosiglitazone. Once low-density lipoprotein cholesterol is at an accepted level, physicians are advised to address the metabolic syndrome and hypertriglyceridemia. Therefore, the ATP III prefers the initial use of a cholesterol-lowering agent to HRT for CHD risk reduction in postmenopausal women. The results of the analyses of the diabetic subgroups in the major statin intervention trials are shown in Table 1.10-17The strongest evidence for the beneficial effect of cholesterol lowering with statins in diabetic individuals with and without evidence of CVD and average cholesterol values comes from the Heart Protection Study(HPS)11 and the Collaborative Atorvastatin Diabetes Study(CARDS),10 the first statin trial conducted only in diabetic subjects. Atherosclerosis is a major risk factor for heart attack and stroke. (2020). Women typically need more HDL (good cholesterol) than men. Children can benefit from getting involved in meal planning, shopping, and cooking, reducing intake of sweetened beverages, and learning how to eat more fruits and vegetables. The good news is that lifestyle changes are reasonably effective in helping you reduce cholesterol levels. The goal for triglycerides is less than 150 mg/dl. There is no quick fix for reducing cholesterol, but there are plenty of ways to reduce your cholesterol naturally. AthyrosVG,Papageorgiou AA, Athyrou VV, Demitriadis DS, Kontopoulos AG: Atorvastatin and micronized fenofibrate alone and in combination in type 2 diabetes with combined hyperlipidemia. Cholesterol and triglyceride values were 250 and 177 mg/dL, respectively AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on management! 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