We agree that statin therapy is first-line treatment for primary prevention of atherosclerotic cardiovascular disease for patients with diabetes mellitus who are 40 to 75 years of age.1 However, severe hypertriglyceridemia (fasting triglycerides ≥ 500 mg/dL and especially > 1,000 mg/dL) in diabetic patients, such as our patient,2 may warrant pharmacologic therapy with fibric acid derivatives, fish oil, or both to reduce the risk of acute pancreatitis.3 Thus, lifestyle modifications, glycemic control with oral hypoglycemic agents, and fenofibrate therapy were initially prescribed to our patient.2
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