Current and future trends in therapy for dyslipidemias

Area of Science:

• Cardiovascular Medicine
• Endocrinology
• Lipidology

Background:

• Dyslipidemia is a common comorbidity in non-insulin-dependent diabetes mellitus (NIDDM).
• The specific atherogenic lipoprotein profile in NIDDM patients is linked to increased cardiovascular event risk.
• Understanding this profile is crucial for effective cardiovascular risk management in diabetic patients.

Purpose of the Study:

• To characterize the atherogenic lipoprotein profile in patients with NIDDM.
• To discuss the treatment implications of this specific lipid profile.
• To assess the cost-effectiveness of lipid management strategies.

Main Methods:

• Review of findings from large clinical trials and patient series.
• Assessment of the effectiveness of various lipid-lowering interventions.
• Cost analysis of dyslipidemia management.

Main Results:

• NIDDM is associated with low-density lipoprotein (LDL) pattern B, characterized by small dense LDL particles, increased triglycerides, and low high-density lipoprotein (HDL) type 2.
• This atherogenic trait often precedes NIDDM diagnosis and identifies individuals at high risk for cardiovascular events.
• Niacin and fibrates are generally more effective than statins for treating LDL pattern B, with lipid management proving cost-effective.

Conclusions:

• Therapeutic strategies targeting triglyceride-rich lipoproteins and small dense LDL are recommended for NIDDM patients.
• Effective lipid management in NIDDM can reduce cardiovascular risk and is a cost-effective intervention.
• Regression of coronary artery disease has been observed with appropriate treatment.