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Treatment of dyslipoproteinaemia in diabetes mellitus
1Department of Medicine, University of Manchester, UK.
Insights
Diabetic patients with high cholesterol face increased coronary heart disease (CHD) risk. Early lipid screening and management, including lifestyle changes and medication, are crucial for preventing premature death in diabetes.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Disorders
Background:
- Coronary heart disease (CHD) is a leading cause of premature mortality in individuals with diabetes mellitus.
- Diabetes is associated with dyslipoproteinaemia, including hypercholesterolaemia, hypertriglyceridaemia, and low high-density lipoprotein (HDL) cholesterol, exacerbating CHD risk.
- Diabetic dyslipoproteinaemia is often more severe, particularly in the presence of nephropathy.
Purpose of the Study:
- To review the current understanding of dyslipoproteinaemia in diabetes and its impact on coronary heart disease (CHD) risk.
- To provide guidance on lipid management strategies for diabetic patients at high risk of CHD.
- To address the reluctance in applying cholesterol-lowering trial results to diabetic populations.
Main Methods:
- Review of existing literature on lipid management in diabetes and CHD.
- Analysis of lipid profiles, including cholesterol and triglycerides, in diabetic patients.
- Evaluation of evidence from cholesterol-lowering trials and their applicability to diabetes.
Main Results:
- Diabetic patients with hypercholesterolaemia have a significantly greater risk of CHD compared to the general population.
- Specific lipid profiles (hypertriglyceridaemia, low HDL) are more prevalent in diabetes, especially type 2.
- Guidelines suggest lipid screening for diabetic patients under 70 with established CHD or specific lipid levels, followed by lifestyle interventions and, if necessary, lipid-lowering medications.
Conclusions:
- Aggressive lipid management is warranted in diabetic patients at high CHD risk, irrespective of trial limitations.
- Fasting lipid measurement is recommended for early detection of dyslipoproteinaemia in at-risk diabetic individuals.
- Treatment strategies should focus on improving glycemic control, weight reduction, dietary modifications, and targeted lipid-lowering drug therapy to reduce non-HDL cholesterol.
Abstract:
Coronary heart disease (CHD) is the most common cause of premature death in diabetes. Hypercholesterolaemia occurs in diabetes with about the same frequency as in the general population, but it confers a greater risk of CHD in diabetes. Hypertriglyceridaemia and low serum high density lipoprotein (HDL) cholesterol levels are more common in diabetes, particularly non-insulin-dependent diabetes. Nephropathy increases the severity of dyslipoproteinaemia. There remains a reluctance to apply the results of cholesterol-lowering trials to diabetes. No trial has been specifically in diabetes, but this should not constrain the treatment of diabetic patients at clearly high CHD risk. It is suggested that fasting lipids should be measured in all diabetic patients aged less than 70 years with established CHD or whose non-fasting cholesterol is >6.00 mmol I(-1) or triglycerides >3.00 mmol I(-1). For those with raised lipids glycaemic control should be improved, if possible, and dietary therapy aimed at a decrease in fat intake, particularly saturated fat, and weight reduction in the obese. Lipid-lowering drugs are required in patients with CHD and serum cholesterol >5.5 mmol I(-1) with the aim of decreasing non-HDL to <4.00 mmol I(-1). In patients without CHD lipid-lowering drugs should be considered when serum cholesterol exceeds 6.5 mmol I(-1) and the risk of CHD is greater than 20 % over the next 10 years. There is no evidence that pursuing this policy beyond the age of 70 years is beneficial. Diabetic women with dyslipoproteinaemia should, however, be treated in the same way as men. The knowledge that hypertriglyceridaemia and low serum HDL cholesterol are present helps in the assessment of CHD risk and the choice of medication to decrease non-HDL cholesterol, but there is no evidence that their treatment in the absence of raised cholesterol is of benefit.