Having Diabetes. Medication for lowering LDL?
Was also considering asking the doctor about a bile acid sequestration medication, would adding this do much to lower cholesterol in combination with the medication?
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Diabetes, particularly type 1, is a tough chronic disease in which both long term good glucose control and lipid goals are known to reduce complications, particularly microvascular ones such as retinopathy, kidney disease and nerve damage. From several studies such as HPS we know that strict control of LDL pays a great bang for the buck; the current desired level is as close as 70 as we can.... as you well mentioned, most patients will need a very healthy diet, a strong statin or combination therapy to get there.
Niacin has proven again and again to be a failure to reduce bad cardiovascular outcomes, in trials such as AIM HIGH and HPS THRIVE... I do not recommend niacin to anyone currently on the basis of those trials. I would rather have my patient on a stronger statin such as rosuvastatin (definitely stronger than lovastatin). Finally, bile sequestrants are a good adjunct, but definitely as a second line of therapy if high dose statin does not get the LDL to goal; their side effect profile is more cumbersome and they are contraindicated if tryglicerides are high.
Hope this is helpful; wish you both the best health, blessings!
Dr Brenes Salazar MD
Mayo Clinic MN
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