title: The nuances of atherogenic dyslipidemia in diabetes: focus on triglycerides and current management strategies.
abstract: Diabetes mellitus (DM) is a pandemic disease and an important cardiovascular (CV) risk factor. The atherogenic dyslipidemia in diabetes (ADD) is characterized by high serum triglycerides, high small dense LDL levels, low HDL levels and postprandial lipemia. Insulin resistance is a primary cause for ADD. Though statins are highly effective for CVD prevention in DM but a significant residual CV risk remains even after optimal statin therapy. Fibrates, niacin and omega-3 fatty acids are used in addition to statin for treatment of ADD (specifically hypertriglyceridemia). All these drugs have some limitations and they are far from being ideal companions of statins. Many newer drugs are in pipeline for management of ADD. Dual PPAR α/γ agonists are in most advanced stage of clinical development and they have a rational approach as they control blood glucose levels (by reducing insulin resistance, a primary factor for ADD) in addition to modulating ADD. Availability of dual PPAR α/γ agnosits and other drugs for ADD management may improve CV outcomes and decrease morbidity and mortality in diabetic patients in future.
authors.affiliation: Director, Manoria Heart Care & Critical Care Hospital, Bhopal, India.
authors.forename: P C
authors.initials: PC
authors.lastname: Manoria
authors.affiliation: Sr. Consultant Cardiologist, Moolchand Medcity, New Delhi 19, India. Electronic address: drhkchopra@gmail.com.
authors.forename: H K
authors.initials: HK
authors.lastname: Chopra
authors.affiliation: Sr. Consultant Cardiologist, Metro Heart Institute, New Delhi, India.
authors.forename: S K
authors.initials: SK
authors.lastname: Parashar
authors.affiliation: Prof., Cardiology, Vivekananda Institute of Medical Sciences, Kolkata, India.
authors.forename: A L
authors.initials: AL
authors.lastname: Dutta
authors.affiliation: Chief Cardiologist, Holy Family Hospital, Mumbai, India.
authors.forename: Brian
authors.initials: B
authors.lastname: Pinto
authors.affiliation: Director, Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India.
authors.forename: Ajit
authors.initials: A
authors.lastname: Mullasari
authors.affiliation: Medical Advisor, Cadila Healthcare, Ahmedabad, India.
authors.forename: Samir
authors.initials: S
authors.lastname: Prajapati
mesh_terms: D050197:Atherosclerosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D019468:Disease Management; D050171:Dyslipidemias / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D009525:Niacin / Q000627:therapeutic use; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014280:Triglycerides; D009525:Niacin
keywords: Atherogenic dyslipidemia in diabetes; Dual PPAR alpha and gamma agonists; Hypertriglyceridemia; Saroglitazar