Dyslipidemia Management in Adults With Diabetes
- American Diabetes Association
- ADA, American Diabetes Association
- CHD, coronary heart disease: CVD, cardiovascular disease
- MNT, medical nutrition therapy
- NCEP, National Cholesterol Education Program
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 cardiovascular disease (CVD).
PREVALENCE OF DYSLIPIDEMIA IN TYPE 2 DIABETES
The most common pattern of dyslipidemia in patients with type 2 diabetes patients is elevated triglyceride levels and decreased HDL cholesterol levels. The mean concentration of LDL cholesterol in those with type 2 diabetes is not significantly different from that in those individuals who do not have diabetes. However, qualitative changes in LDL cholesterol may be present. In particular, patients with diabetes tend to have a higher proportion of smaller and denser LDL particles, which are more susceptible to oxidation and may thereby increase the risk of cardiovascular events. Insufficient data are available to make recommendations on the measurement of particle size in clinical practice.
As in those who do not have diabetes, lipid levels may be affected by factors unrelated to glycemia or insulin resistance, such as renal disease, hypothyroidism, and 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 in some patients with diabetes. Furthermore, use of alcohol or estrogen may also contribute to hypertriglyceridemia.
LIPOPROTEIN RISK FACTORS FOR CVD
Available prospective cohort studies suggest that lipid abnormalities are associated with increased risk of cardiovascular events in patients both with and without diabetes. Various studies have demonstrated that LDL, HDL, and triglycerides are independent predictors of CVD (2).
CLINICAL TRIALS OF LIPID LOWERING IN DIABETIC SUBJECTS
The recently completed Heart Protection Study has been the largest study to date, enrolling and randomizing 5,963 patients age >40 years with diabetes and total cholesterol >135 mg/dl. In this trial, patients with diabetes assigned to simvastatin had a 22% reduction (95% CI 13–30) in …
