Lowering triglycerides and increasing HDL cholesterol with a fibrate is associated with a reduction in cardiovascular events in patients with clinical CVD, low HDL, and near-normal levels of LDL. In women, an HDL goal 10 mg/dl higher may be appropriate. Lower LDL cholesterol to 40 mg/dl (1.15 mmol/l). Patients who do not achieve lipid goals with lifestyle modifications require pharmacological therapy. Lifestyle modification focusing on the reduction of saturated fat and cholesterol intake, weight loss, increased physical activity, and smoking cessation has been shown to improve the lipid profile in patients with diabetes. Some (but not all) studies suggest that a high–monounsaturated fat diet may have better metabolic effects than a high-carbohydrate diet, although other experts have suggested that such a dietary modification may make weight loss more difficult in obese patients with diabetes. The ADA suggests an increase in either carbohydrate or monounsaturated fat to compensate for the reduction in saturated fat. The proportion of saturated fat in the meal plan should be reduced. Patients with diabetes who are overweight should be given a prescription for MNT and for increased physical activity. Weight loss and increased physical activity will lead to decreased triglycerides and increased HDL cholesterol levels and also to modest lowering of LDL cholesterol levels. The ADA has made recommendations for both medical nutrition therapy (MNT) ( 5) and physical activity ( 6). Observational studies suggest that patients who report healthier diets and greater physical activity have fewer cardiovascular events ( 5, 6).
There is little evidence from clinical trials to determine the effect of different dietary interventions on the incidence of cardiovascular events.
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