Management of Dyslipidemia in Adults With Diabetes
- American Diabetes Association
RATIONALE FOR TREATMENT OF DYSLIPIDEMIA
The rationale for the treatment of diabetic dyslipidemia is discussed in detail in the American Diabetes Association (ADA) technical review “Management of Dyslipidemia in Adults With Diabetes” (1). Type 2 diabetes is associated with a two- to fourfold excess risk of coronary heart disease (CHD). Although the degree of glycemia in diabetic patients is strongly related to the risk of microvascular complications (retinopathy and renal disease), the relation of glycemia to macrovascular disease in type 2 diabetes is more modest. The finding of increased cardiovascular risk factors before the onset of type 2 diabetes also suggests that aggressive screening for diabetes combined with improved glycemic control alone will not be likely to completely eliminate excess risk of CHD in type 2 diabetic patients. Clearly, a multifactorial approach to prevention of CHD in type 2 diabetes will be necessary.
PREVALENCE OF DYSLIPIDEMIA IN TYPE 2 DIABETES
The most common pattern of dyslipidemia in type 2 diabetic patients is elevated triglyceride levels and decreased HDL cholesterol levels. The concentration of LDL cholesterol in type 2 diabetic patients is usually not significantly different from nondiabetic individuals. Diabetic patients may have elevated levels of non-HDL cholesterol (LDL plus VLDL). However, type 2 diabetic patients typically have a preponderance of smaller, denser LDL particles, which possibly increases atherogenicity even if the absolute concentration of LDL cholesterol is not significantly increased. Lastly, as shown in the technical review (1), the median triglyceride level in type 2 diabetic patients is <200 mg/dl (2.30 mmol/l), and 85–95% of patients have triglyceride levels below 400 mg/dl (4.5 mmol/l).
As in nondiabetic individuals, lipid levels may be affected by factors unrelated to glycemia or insulin resistance, such as renal disease, hypothyroidism, and the frequent occurrence of genetically determined lipoprotein disorders (e.g., familial combined hyperlipidemia and familial hypertriglyceridemia). These genetic disorders may contribute to the severe hypertriglyceridemia seen …