Exploring emerging pharmacotherapies for type 2 diabetes patients with hypertriglyceridemia

Area of Science:

• Endocrinology
• Cardiovascular Medicine
• Pharmacology

Background:

• Atherogenic dyslipidemia, characterized by high triglycerides, low HDL, and small dense LDL, elevates cardiovascular (CV) risk in type 2 diabetes (T2D).
• This dyslipidemia represents a significant residual CV risk even when LDL cholesterol is at target levels.

Purpose of the Study:

• To review emerging therapies for triglyceride reduction in patients with T2D.
• Focus on novel agents including pemafibrate, apoC3 inhibitors, and ANGPTL3 inhibitors.

Main Methods:

• Literature search of PubMed database.
• Review of studies on pemafibrate, apoC3 inhibitors (olezarsen, plozasiran), and ANGPTL3 inhibitors (evinacumab).

Main Results:

• Pemafibrate reduced triglycerides in T2D but did not show CV event reduction in the PROMINENT study.
• ApoC3 inhibitors demonstrate efficacy in lowering triglycerides, with agents like olezarsen and plozasiran under investigation for combined hyperlipidemia.
• ANGPTL3 inhibitors, such as evinacumab, are approved for familial hypercholesterolemia and may offer future benefits for T2D triglyceride management.

Conclusions:

• Current triglyceride-lowering therapies for T2D have limitations in efficacy and CV benefit evidence.
• Novel therapies targeting apoC3 and ANGPTL3 present promising avenues for managing dyslipidemia and reducing residual CV risk in T2D.