Recent Advances in the Treatment of Atherogenic Dyslipidemia in Type 2 Diabetes Mellitus

摘要

Despite best treatment efforts reducing low-density lipoprotein cholesterol, a substantial number of type 2 diabetes mellitus patients still experience progression of cardiovascular risk. Even with intensification of statin therapy, a substantial residual cardiovascular risk remains and atherogenic dyslipidemia is an important driver of this so-called residual risk. Besides statin therapy, new strategies evaluate the role of intensive combination lipid treatment for the entire type 2 diabetic population. The results from the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Lipid trial suggest that there is a lipid-related modifiable component to cardiovascular residual risk in statin-treated type 2 diabetic patients, and that further research should address patients with triglycerides above 204 mg/dl and high-density lipoprotein cholesterol below 34 mg/dl. Based on their respective lipid-modifying activity, the combination of a fibrate and statin is a logical approach to improving achievement of lipid targets in statin-treated patients with a glomerular filtration rate of >60 ml/min/1.73 m2 and with residual atherogenic dyslipidemia. The link between dyslipidemia treatment and diabetic retinopathy, nephropathy and neuropathy is an emerging new field and microvascular complications are targets for new treatments.