Cardiovascular disease risk of type 2 diabetes mellitus and metabolic syndrome: focus on aggressive management of dyslipidemia.
Type 2 diabetes mellitus and the closely related metabolic syndrome markedly increase the risk of cardiovascular disease a major contributor is the dyslipidemia. Recent studies and new national guidelines suggest these very high risk patients with cardiovascular disease achieve optional low density lipoprotein cholesterol (LDL-C) level of less than 70 mg/dl. In addition there may be no threshold to begin therapeutic lifestyle change and pharmacologic therapy to reduce LDL-C by 30-40%. Although randomized controlled trials with statins indicate that LDL reduction clearly reduces cardiovascular risk in these patients, the typical dyslipidemia of type 2 diabetes mellitus is also characterized by low high density lipoprotein cholesterol (HDL-C) levels, increased triglyceride-rich lipoproteins and small dense LDL, as well as increased postprandial lipemia. The later lipoproteins increase non-HDL-C levels. In order to address these abnormalities it may be necessary to utilize combined approaches with a fibrate or nicotinic acid, or other agents with statins to help reduce risk beyond statins. In addition, supervised, therapeutic life-style change is often underutilized therapy in patients with established coronary artery disease. This review will focus on maximizing the treatment of dyslipidemia in type 2 diabetes and the metabolic syndrome and discuss the evidence based studies and new developments in the management in these very high risk patients.
Falko
James M
JM
McConnell Heart Health Center, 3773 Olentangy River Road, Columbus, Ohio 43214, USA. falkoj@ohiohealth.com
Moser
Robert J
RJ
Meis
Sophia B
SB
Caulin-Glaser
Teresa
T
D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000069059:Atorvastatin; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000453:epidemiology*; D050171:Dyslipidemias / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology*; D006538:Heptanoic Acids / Q000627:therapeutic use; D006801:Humans; D024821:Metabolic Syndrome / Q000150:complications*; D009525:Niacin / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D014280:Triglycerides / Q000097:blood; D014481:United States / Q000453:epidemiology
D000924:Anticholesteremic Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D011758:Pyrroles; D014280:Triglycerides; D009525:Niacin; D000069059:Atorvastatin