Figure 6.

Proposed algorithm for the management of high-risk individuals with elevated triglycerides and/or low HDL cholesterol at LDL cholesterol goal. ^aLDL-C at goal as recommended by the most recent European guidelines (2007);⁴ <2.5 mmol/L in high-risk patients, decreasing to <2.0 mmol/L in very high risk patients. High-dose omega-3 fatty acids, fibrate, or niacin may be considered if the patient has very high TG (>5.0 mmol/L) to prevent pancreatitis. ^bIf the patient still has elevated TG (≥1.7 mmol/L, as recommended by the most recent European guidelines⁴) and/or low HDL-C (<1.0 mmol/L) despite intensive lifestyle intervention, and addressing compliance with pharmacotherapy and secondary causes of dyslipidaemia, additional lipid-modifying therapy may be considered. ^cBased on clinical outcome data and safety considerations for combination statin–fibrate therapy, fenofibrate is the preferred fibrate. This fibrate may have particular value in patients with T2DM and mild-to-moderate retinopathy. ^dGreater LDL-C lowering may be achieved by the addition of ezetimibe to a statin. Ezetimibe has a dose-sparing advantage in patients intolerant of higher dose statins, although outcome evidence to support its use is awaited. Note: To convert LDL-C or HDL-C from mmol/L to mg/dL multiply by 38.7; to convert TG from mmol/L to mg/dL multiply by 88.5. Abbreviations: TG, triglycerides; HDL-C, high-density-lipoprotein cholesterol; LDL-C, low-density-lipoprotein cholesterol.