Kumar and Singh Dovepress nuclear receptor that, when activated, works at the genetic well documented, along with the long-term cardiovascular level by regulating lipid and glucose metabolism as well as morbidity and mortality risk. Despite ongoing research, tech- inflammation.26 There are three types of PPARs, ie, PPARα, nologic advances, and newer medications that work increas- PPARγ, and PPARδ, all of which are found in organs ingly at the genetic level, the best and most cost-effective throughout the body. Fibric acid derivatives (ie, gemfibrozil treatment remains prevention. Preventing the development and fenof ibrate) have been used in the treatment of of type 2 DM and its associated cardiometabolic disturbance hyperlipidemia. They have also been shown to produce their involves early adoption of a healthy lifestyle that incorporates effects through PPARα.26–29 It should be noted that in the diet modification, increased exercise, and regular health care Fenofibrate Intervention and Event Lowering in Diabetes maintenance visits with a primary care physician. Once diag- (FIELD) study that, compared with placebo, fenofibrates nosed, the management involves decreasing the atherogenic failed to reach statistical significance in reducing the primary components by adherence to the NCEP-ATP III and ADA study outcome, ie, CHD or nonfatal myocardial infarction, recommendations, so that the patient and the health system but did show a statistically significant reduction in total may forestall the ensuing cardiovascular morbidity and mor- cardiovascular events. However there are questions related tality, as well as its associated financial burden. to the use of statins in the placebo arm.37 Thiazolidinediones, which are oral antidiabetic agents, also activate PPARγ and thereby increase adiponectin levels.26,33 Increasing adiponectin levels has been shown in animal trials to reduce weight in mice given high-fat diets.30 Furthermore, adiponectin has been shown to activate the adenosine monophosphate-protein kinase (AMPK) cascade which regulates energy homeostasis in the body.31 The AMPK cascade is also a target for metformin, another oral antidiabetic medication.32 Despite these advances in knowl- edge about the pathophysiology of diabetes, translating this knowledge into clinical practice has been difficult due to drug side effects and increased morbidity.26,33 It is also worth mentioning that the recent Bypass Angio- plasty Investigation 2 Diabetes (BARI 2D) study found that in 2368 type 2 diabetic patients with heart disease, those with stable ischemic heart disease who received optimal medical management showed no significant disadvantage in terms of the primary endpoint of death or the composite endpoint of death, myocardial infarction, or stroke, compared with those undergoing prompt revascularization only or those with stable ischemic heart disease who underwent delayed revascularization.34 These findings have strong implications with respect to cardiac revascularization in type 2 diabetics. However, in terms of primary care, this study shows that optimal medical management of a patient with type 2 diabetes has significant cost benefits without increasing morbidity or mortality, and may become the standard of care in this patient population. Conclusions In summary, the current status, associated cardiovascular risk, expected increase in prevalence, and projected monetary costs associated with DM and atherogenic dyslipidemia are 668 submit your manuscript | www.dovepress.com Dovepress Disclosure The authors report no conflict of interest in this research. References 1. Cardiovascular diseases (CVDs). Fact sheet No.317. Sep 2009. Geneva: World Health Organization; 2009. 2. American Heart Association. Cardiovascular Disease Statistics. 2010. Available from: http://www.americanheart.org/presenter. jhtml?identifier=4478. Accessed May 20, 2010. 3. Wilson PWF, D’Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories. 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