International Circulation: Residual risks for T2DM patients are much higher compared to non diabetics even on high anti-hypertensive hypoglycemic and LDL-C reduction therapy， what are the reasons for this?
　　Prof Alberto Zambon: The risk of macro and micro-vascular complications remains consistently high even under the best standard of care. The reason for this is that there are macro and micro-vascular complications we can modify and then there are those we cannot modify. We will never reduce the risk of these complications down to zero. On the other hand those complications which are modifiable are definitely under treated and this is one of the reasons why they remain high in T2DM patients.
　　International Circulation: What’s the relationship between T2DM and atherogenic dyslipidemia? Why is atherogenic dyslipidemia more dangerous in T2DM patients?
　　Prof Alberto Zambon: The risk of atherogenic dyslipidemia is consistently high because it is a major component of the pathophysiological pathway that leads to insulin resistance. What is atherogenic dyslipidemia? It is the reduction in the bodies good cholesterol， increased levels of triglycerides and even though levels of the bad cholesterol (LDL) in most of the times are only mildly elevated， the lipoproteins that carry the LDL cholesterol are particularly nasty because they are small， dense and easily oxidized. Collectively， these factors make them dangerous for the arterial wall.
　　International Circulation: The efficacy of CV risk reduction with statin which is the standard therapy for dyslipidemia in T2DM patients differ from that in the general population?
　　Prof Alberto Zambon: For non diabetic patients who have a risk of cardiovascular disease should be placed on statin therapy as the first therapeutic choice. This mainly if hypercholesterolemia is a major phenotype of those patients. Statins should remain the first choice not only to reduce the risk of cardiovascular events in diabetics but also non diabetics also.
　　International Circulation: So can we optimize reduction of micro vascular risks in T2DM， and what is the role of triglyceride lowering by fibrates?
　　Prof Alberto Zambon: When we talk about residual risks， all the trials with statins have pointed out that there are a subset of patients with a considerable higher risk of these complications than others. One example is represented by diabetic patients who are on a statin，whom still have low levels of HDL and high levels of triglycerides. This is one of the areas where fibrates kicks in because these agents affect HDL and triglycerides and not on LDL. The other point which is somewhat of a surprise is that trials concerning fibrates particularly the two most recent ones presented positive findings on micro vascular complications specifically: diabetic retinopathy and diabetic nephropathy.
　　International Circulation: Which kind of T2DM patients should be considered to receive mono- or combo- therapy of Fenofibrate & Statin in order to reduce residual micro-vascular risks? How about the safety and tolerance of fibrates-based therapy?