Patients with diabetes who were given two popular cholesterol-lowering drugs at the same time saw a "remarkable" drop in cholesterol levels, according to LDS Hospital heart researchers. They believe the results would likely be similar for others with a "mixed type" of cholesterol-fatty disorder.

The researchers saw a 52-point decrease in triglyceride levels when study participants took both fenofibrate and simvastatin. Triglycerides are a form of fat that circulates in the blood.

Simvastatin is typically used to treat high LDL or "bad" cholesterol levels, said Dr. Jeffrey Anderson, LDS Hospital associate chief of cardiology. Fenofibrate is prescribed because it lowers triglycerides and raises HDL "good" cholesterol levels.

Typically, patients are told to try to keep their LDL cholesterol below 100, triglycerides below 150 and HDL above 50. But many people, including those with diabetes, are prone to have various combinations of cholesterol-level challenges. And diabetes itself confers a high risk of heart attack — equivalent to the risk of a second heart attack for someone who has already had one, Anderson said.

The researchers told the 56th annual scientific sessions of the American College of Cardiology recently that higher doses of simvastatin might yield even better results. For the study, they used a 20 milligram-dose of simvastatin (Zocor) for patients with type II diabetes. Anderson said a dose twice that has been proven safe.

They tested the two drugs individually and in combination among 300 patients with abnormal cholesterol levels who had type 2 diabetes but not coronary artery disease, said Heidi May, an LDS Hospital epidemiologist. For the first three months, a patient was randomly assigned to receive simvastatin, fenofibrate or both. Then they all received both drugs for another nine months.

The drugs complement each other. Simvastatin is prescribed to lower both total and LDL cholesterol, while fenofibrate is prescribed to lower triglyceride levels and raise HDL cholesterol levels.

May said the findings may lead to development of a dual-action treatment that targets all the different cholesterol parameters.

One day, Anderson predicted, the two drugs might be packaged together in a single prescription.

"That would be helpful to make it easier to take, and that improves compliance," he said. He believes the combination could prove very helpful with a condition called metabolic syndrome, which is a kind of pre-diabetes. Those patients are generally overweight and have elevated blood sugars but not to the level of having diabetes. They also have high blood pressure and a mixed type of lipidemia, just like those with diabetes.

"They're the next natural group of people to extend this to," said Anderson.

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