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19.12.2017 | Review Article

New treatment options for lipid-lowering therapy in subjects with type 2 diabetes

verfasst von: Roberto Scicali, Antonino Di Pino, Viviana Ferrara, Francesca Urbano, Salvatore Piro, Agata Maria Rabuazzo, Francesco Purrello

Erschienen in: Acta Diabetologica | Ausgabe 3/2018

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Abstract

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 cholesterol reduces the risk of cardiovascular death. Therefore, the European guidelines for the management of dyslipidemias recommend an LDL cholesterol goal < 100 mg/dL in diabetic subjects without cardiovascular events. Moreover, if triglycerides (TG) are elevated (> 400 mg/dL), they recommend a non-HDL cholesterol goal < 130 mg/dL 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 TG and low HDL cholesterol. Regarding new therapies, recent data from phase III trials show that proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors considerably decrease LDL cholesterol. Thus, they may be useful in diabetic patients with concomitant diseases such as familial dyslipidemia, recurrent cardiovascular events, and elevated LDL cholesterol after second drug administration in addition to maximal statin dose or statin intolerance.

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Titel: New treatment options for lipid-lowering therapy in subjects with type 2 diabetes
verfasst von: Roberto Scicali
Antonino Di Pino
Viviana Ferrara
Francesca Urbano
Salvatore Piro
Agata Maria Rabuazzo
Francesco Purrello
Publikationsdatum: 19.12.2017
Verlag: Springer Milan
Erschienen in: Acta Diabetologica / Ausgabe 3/2018
Print ISSN: 0940-5429
Elektronische ISSN: 1432-5233
DOI: https://doi.org/10.1007/s00592-017-1089-4

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Klimawandel und Gesundheit: Was Sie in der Hausarztpraxis wissen müssen und tun können

Springer Medizin

New treatment options for lipid-lowering therapy in subjects with type 2 diabetes

Abstract

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Triglyzeridsenker schützt nicht nur Hochrisikopatienten

Gibt es eine Wende bei den bioresorbierbaren Gefäßstützen?

Vorsicht, erhöhte Blutungsgefahr nach PCI!

Wie managen Sie die schmerzhafte diabetische Polyneuropathie?

Update Innere Medizin

Klimawandel und Gesundheit: Was Sie in der Hausarztpraxis wissen müssen und tun können

Springer Medizin

Abstract

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Weitere Artikel der Ausgabe 3/2018

Diabetes and number of years of life lost with and without cardiovascular disease: a multi-state homogeneous semi-Markov model

Treatment of mild-to-moderate hypoglycemia in patients with type 1 diabetes treated with insulin pump therapy: are current recommendations effective?

Intensive dietary intervention promoting the Mediterranean diet in people with high cardiometabolic risk: a non-randomized study

The metabolism and transport of 1,5-anhydroglucitol in cells

Efficacy of self-monitoring blood glucose as a key component of a chronic care model versus usual care in type 2 diabetes patients treated with oral agents: results of a randomized trial

Agonistic autoantibodies against adrenergic receptors correlating with antihypertensive therapy in long-standing diabetes type 2

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Triglyzeridsenker schützt nicht nur Hochrisikopatienten

Gibt es eine Wende bei den bioresorbierbaren Gefäßstützen?

Vorsicht, erhöhte Blutungsgefahr nach PCI!

Wie managen Sie die schmerzhafte diabetische Polyneuropathie?

Update Innere Medizin