<International Circulation>: Professor Hu， if you had patient with both high triglycerides and low HDL would you add any other medication?

　　Prof. Hu:In my experience with a large number of patients is that education and lifestyle modification does seem to be adequately effective.  Many of my patients really do follow my recommendations to do more exercise and modify their diet.  I have observed substantial reductions in triglyceride levels.  We don’t have any hard evidence to support the use of other drugs for this intervention.

　　Prof. Eckel:  Please don’t misunderstand me.  I am a huge supporter of healthy lifestyles; I am only saying that the expectation may be too high.  A weight reduction of 5-7% may not actually change HDL or triglycerides that much.

　　<International Circulation>:  For diabetic patients， how much more important is it to treat their triglyceride level?

　　Prof. Eckel:  We need to first understand what ranges we are talking about.  Certainly triglyceride levels above 500mg/dl， which would be in the range of 5.5mmol.  These ranges would certainly need to be treated because patients with severe hypertriglyceridemia can get even more severe and get pancreatitis.  Drugs typically work well in that range at lowering triglycerides.  Once levels get above 1000mg/dl the same drugs stop working so well and it is necessary to restrict dietary fats.  Above levels of 500mg/dl clearly everyone should be treated.  This would be consistent with FDA approval for many drugs.

　　<International Circulation>:  Referring to one point brought up earlier regarding the decrease in retinopathy and the decrease in vascular events associates with phenol-fibrate.  Have either of you used fibrates in patients regardless of their LDL or triglyceride levels if they have diabetes?

　　Prof. Hu:The micro-vessel risk in diabetics is much more and it is necessary to proceed cautiously before adding additional drugs.

　　Prof. Eckel:  We really need to consider the phenotype of data and wait for a study with a good representative population of patients where retinopathy risk is assessed.  We really need the right kind of trial to support the use of these drugs for a benefit that was not intended.