Advances in Lipid Testing and Management in Patients with Diabetes Mellitus |
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| Institution: | 1. Medical University of Graz, Department of Internal Medicine, Division of Cardiology, Graz, Austria;2. Medical University of Graz, Department of Internal Medicine, Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Graz, Austria;3. Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Abu Dhabi, UAE;5. Klinikum Klagenfurt, Abteilung für Innere Medizin und Kardiologie, Austria;6. Medical University of Vienna, Department of Cardiology, Vienna, Austria;7. Ordensklinikum Linz Elisabethinen, Innere Medizin 2 mit Kardiologie, Angiologie und Intensivmedizin, Austria;8. University Hospital St. Pölten, Department of Internal Medicine III, St.Pölten, Austria;9. Klinik Ottakring, Abteilung für Kardiologie, Wien, Austria;10. Landesklinikum Wiener Neustadt, Abteilung für Innere Medizin, Kardiologie und Nephrologie, Wiener Neustadt, Austria;11. Kepler University Hospital Linz, Department of Cardiology and Intensive Care Medicine, Linz, Austria;12. Medical University of Innsbruck, University Clinic of Internal Medicine III/Cardiology and Angiology, Innsbruck, Austria |
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| Abstract: | ObjectiveTo review the pathophysiologic basis for the classic phenotype associated with diabetic dyslipidemia, discuss recent advances in lipid and lipoprotein testing for risk assessment and lipid therapy monitoring, and summarize a systematic approach to the clinical management of diabetic dyslipidemia.MethodsWe review the pertinent literature, including treatment guidelines and results of major clinical trials, and discuss the effectiveness of various pharmacologic interventions for management of lipid levels in patients with diabetes.ResultsThe incidence and prevalence of type 2 diabetes mellitus continue to escalate globally at alarming rates. Diabetes predisposes to multiple microvascular and macrovascular complications, including cardiovascular disease, the number 1 cause of mortality in the United States. The third report of the National Cholesterol Education Program Adult Treatment Panel in 2001 identified diabetes as a coronary heart disease (CHD) risk equivalent, in light of the evidence that CHD risk in persons with diabetes is similar to that of nondiabetic persons with established CHD. Diabetic dyslipidemia is characterized by a constellation of lipid derangements—hypertriglyceridemia, a low concentration of high-density lipoprotein cholesterol (HDL-C), and a high concentration of small, dense low-density lipoprotein (LDL) particles—that accelerate the progression of atherosclerotic disease and the development of atherothrombotic events.ConclusionStatin trials have demonstrated significant reductions in morbidity and mortality from cardiovascular diseases, including in patients with diabetes. Nevertheless, many patients who achieve their LDL cholesterol (LDL-C) goal still have residual CHD risk. Diabetic dyslipidemia contributes to this residual risk because of the increased concentration of atherogenic apolipoprotein B-containing lipoproteins that can persist despite normalized LDL-C levels and low HDL-C levels. Recent clinical trials emphasize the importance of intensive lipid lowering to achieve recommended goals for LDL-C, non-HDL-C, and apolipoprotein B. (Endocr Pract. 2009;15:641-652) |
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