Diabetic Dyslipidemia

Abstract

In patients with type 2 diabetes (T2D), increased levels of small and dense low density lipoprotein (sd-LDL), low levels of high density lipoprotein (HDL) cholesterol, and mild or severe hypertriglyceridemia define a well-studied phenotype known as atherogenic dyslipidemia. Although triglycerides and HDL are powerful predictors of cardiovascular (CV) outcome, it remains unclear whether pharmacological modulation of these lipid fractions may effectively reduce CV morbidity and mortality. Over the last few years, recent randomized trials were launched to investigate whether treating atherogenic dyslipidemia may reduce CV events. Unfortunately, long-term treatment with fibrates, niacin, or CETP inhibitors was unable to show any reduction of the composite CV endpoints, including fatal and nonfatal myocardial infarction, stroke and mortality. In some cases, HDL-raising approaches by torcetrapib even increased CV mortality. Taken together, evidence available so far does not encourage strategies aimed at modulating triglycerides and HDL, unless severe hypertriglyceridemia is diagnosed. Reduction of LDL-C remains the primary target of therapy in T2D patients. In this regard, reducing LDL-C by 30–40 % from baseline may be considered an acceptable outcome for patients who cannot reach recommended LDL cholesterol goals (<100 or <70 mg/dL according to CV risk) due to severe baseline elevations in LDL cholesterol and/or intolerance to maximal, or any, statin doses.