New hypolipidemic agents in the treatment of diabetic dyslipidemia


Authors: Vladimír Bláha ;  Jakub Víšek
Authors‘ workplace: III. interní gerontometabolická klinika, LF UK a FN Hradec Králové
Published in: AtheroRev 2019; 4(2): 75-81
Category: Reviews

Overview

Dyslipidemias represent a variety of quantitative and/or qualitative lipoprotein abnormalities. According to etiology, we distinguish primary dyslipidemias with strictly genetic background and secondary ones with their origin in other disease or pathological states. Diabetic dyslipidemia is a type of secondary dyslipidemia and plays an important role in determining the cardiovascular risk of subjects with type 2 diabetes. In these patients, insulin resistance is responsible for overproduction and secretion of atherogenic very low density lipoprotein. In addition, insulin resistance promotes the production of small dense low-density lipoprotein (LDL) and reduces high-density lipoprotein (HDL) production. Cardiovascular disease remains a leading cause of morbidity and mortality in diabetic patients. Previous results support the role for small, dense LDL particles in the etiology of atherosclerosis and their association with coronary artery disease. Moreover, lowering LDL-C reduces the risk of cardiovascular death. Therefore, the European guidelines for the management of dyslipidemias recommend an LDL-C goal < 2.6 mmol/l in diabetic subjects without cardiovascular events. Moreover, if triacylgly­cerols (TAG) are elevated, they recommend a non-HDL-C goal < 3.4 mmol/l in diabetic individuals without cardiovascular events. Statins are the first line of LDL-lowering therapy in diabetic patients and combined therapy with ezetimibe and statins could be useful in very high cardiovascular risk diabetic subjects. Furthermore, the effect of a fibrate as an add-on treatment to a statin could improve the lipid profile in diabetic individuals with high TAG and low HDL-C. Regarding new the­rapies, recent data from phase III trials show that proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors con­siderably decrease LDL-C. Thus, they may be useful in diabetic patients with concomitant diseases such as familial dyslipid­emia, recurrent cardiovascular events, and elevated LDL-C after second drug administration in addition to maximal statin dose or statin intolerance.

Keywords:

atherosclerosis – cardiovascular disease – cardiovascular risk – diabetes mellitus – hypercholesterolemia – LDL-cholesterol


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Angiology Diabetology Internal medicine Cardiology General practitioner for adults
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