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Statins are the most commonly prescribed cholesterol-lowering drugs for cardiovascular prevention. Data from randomized clinical trials have shown an increased risk of diabetes mellitus type 2 (DT2) on statin treatment. These findings have been confirmed in genetic Mendelian randomization studies and in observational cohorts. The molecular mechanisms remain partly unknown. The risk of TD2 is higher with high doses of statins and in people with preexisting risk factors for T2D (prediabetes, metabolic syndrome). The cardiovascular benefit of statins overdrive by far the risk of diabetes and the prescription of statins in high risk cardiovascular subjects should not be questioned. Glycaemic monitoring and the adaptation of lifestyle and dietary measures are recommended for subjects at risk of T2D., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Hypertriglyceridaemia is a common finding in medical practice. The reduction of triglyceride levels may contribute to reduce the cardiovascular risk (at least in patients with low HDL cholesterol) and to avoid the occurrence of acute pancreatitis (in case of severe hypertriglyceridaemia). The discovery of causes of hypertriglyceridaemia (comorbidities, medications) may lead to specific measures. Otherwise, the focus should be put on dietary advises first (reduced caloric intake to promote weight loss, less alcohol, less sucrose), which, if well conducted, may result in spectacular results. If they fail, some pharmacological approaches may be considered, but with generally a limited success rate. Among them, fenofibrate is the best studied and has been shown to be useful for cardiovascular prevention, especially if low HDL cholesterol is associated with hypertriglyceridaemia in patients with type 2 diabetes.

Two clinical trials demonstrate the superiority versus a placebo of two antidiabetic drugs in patients with type 2 diabetes and high cardiovascular risk. Empagliflozin, an inhibitor of sodium-glucose type 2 (SGLT2) cotransporters, in EMPA-REG OUTCOME, and liraglutide, an agonist of glucagon-like peptide-1 (GLP-1) receptors, in LEADER, showed a significant reduction in major cardiovascular events (- 14 and - 13 %, respectively), cardiovascular mortality (- 38 and - 22 %, respectively) and all-cause mortality (- 32 and - 15 %, respectively). A lower progression of kidney disease and less renal events were also reported. The underlying protective mechanisms remain controverted as the discussion whether the benefits are specific to each medication or could be extended to other molecules of these two pharmacological classes., Competing Interests: Le Pr A. J. Scheen déclare avoir reçu des honoraires comme orateur, membre d’un conseil scientifique ou investigateur clinicien de la part des firmes AstraZeneca, Boehringer Ingelheim, Janssen, Lilly, Merck Sharp & Dohme, Novartis, NovoNordisk, et Sanofi. Il a également été investigateur clinicien dans les études EMPA-REG OUTCOME et LEADER. Le Dr Philippe Ernest a été co-investigateur dans l’étude EMPA-REG OUTCOME. Les autres auteurs de cet article n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Type 2 diabetes mellitus is a common chronic disease whose economic impact on both patients and society is constantly increasing. "The Cost of Diabetes in Europe--Type 2 study" is the first coordinated attempt to measure total healthcare costs of type 2 diabetes mellitus in Europe. On average, 3% of the population with type 2 diabetes accounted for 5% of the total healthcare expenditure. Complications have a substantial impact on the costs of managing type 2 diabetes. The prevention of complications, especially cardiovascular disease, will potentially reduce overall healthcare expenditure.