血脂異常是糖尿病患造成冠狀動脈心臟病的最主要原因。數個前瞻性的研究指出史塔丁（Statin）可以有效下降低密度脂蛋白膽固醇和減少心血管問題造成的死亡，但儘管已使用史塔丁治療後，糖尿病患者仍處於心血管事件發生風險。所以有學者指出是否能透過纖維酸類藥物，來增加高密度脂蛋白膽固醇或降低三酸甘油酯，來減少第2型糖尿病患者冠狀動脈心臟病發生率。但是FIELD研究告訴我們，使用纖維酸類藥物並沒有比使用使用史塔丁更具效果。儘管如此，後續FIELD研究結果之分析發現使用fenofibrate後，可以減少糖尿病視網膜病變而需要雷射治療，減少截肢的風險，和減緩微蛋白尿的惡化，而且這些效果似乎與血脂異常改善無直接關係。至於ACCORD研究結果則顯示纖維酸和史塔丁併用，若和單用史塔丁比較，並不會減少心血管事件發生率，但卻可以減緩糖尿病視網病變的惡化。FIELD和ACCORD兩項研究提供了第2型糖尿病患者合併血脂異常，對於使用降血脂藥物選擇的證據依據。整體而言，此兩項大型研究可能改變目前醫師對處方降血脂藥物的策略。至於使用史塔丁加上纖維酸所能及的治療範疇，必須取決於其治療效益和長期安全性的評估，並與成本效益分析取得平衡點。

Dyslipidemia is the principal cause of coronary artery disease in patients with type 2 diabetes mellitus. Severalprospective studies have demonstrated that statin treatment can effectively reduce LDL-C and cardiovasculardeath, though residual risk of cardiovascular events still exist, probably due to hypertriglyceridemia and low HDL-Cin diabetes. Fibrates can increase HDL-C and decrease triglyceride levels, but FIELD study failed to prove thatfibrate treatment was better than statin in reducing coronary artery disease in type 2 diabetes mellitus. However,the subsequent analysis of FIELD study showed that laser treatment for diabetic retinopathy, limb amputation, andmicroalbuminuria were all decreased independent of lipid lowering effects, suggesting some additional benefits offibrates in diabetic microangiopathy. In the ACCORD study, it was demonstrated that the combination of fibratesand statins did not significantly reduce the cardiovascular events compared to statin use alone, but could delaythe progression of diabetic retinopathy. Both the FIELD and ACCORD trials provided us some clinical evidencefor choosing which lipid lower agent in diabetic patients with dyslipidemia. Regarding combined fibrate and statintherapy, its exact benefits still need further study, and a balance between therapeutic efficacy, safety and cost shouldbe considered.