Diabetic Dyslipidaemia - The Case for Using Statins
Type 2 diabetes is associated with an increased risk of coronary heart disease (CHD). The association between CHD and abnormal plasma lipid levels has led current guidelines to recommend pharmacological modification of the lipid profile. Statins are particularly effective at reducing cholesterol levels, with additional benefits on other components of the lipid profile. Lipid-modifying therapy should be used routinely to reduce the risk of CHD in patients with type 2 diabetes.
In addition to microvascular complications, patients with type 2 diabetes demonstrate an increased risk towards developing coronary heart disease (CHD). Haffner et al. noted over a seven-year period that in patients with no history of CHD, the incidence of first myocardial infarction (MI) was over five times greater for patients with diabetes compared with non-diabetic controls, and was similar to the incidence for non-diabetic patients with previous MI. Deaths from cardiovascular causes were also increased in patients with diabetes, with similar rates for diabetic patients with no history of CHD and normoglycaemic patients with CHD. Therefore, all diabetes patients, irrespective of history of CHD, may be considered within the category of secondary CHD prevention, and patients with diabetes and manifestations of CHD appear to be at particularly high risk. In line with this, the most recent National Cholesterol Education Program Adult Treatment Panel guidelines (NCEP ATP III) consider diabetes as a CHD risk equivalent and suggest that patients should be treated accordingly.
Atherogenic dyslipidaemia represents a major risk factor for CHD in patients with diabetes. Diabetic dyslipidaemia may exist in the absence of raised total serum cholesterol due to an increased proportion of the more atherogenic dense low-density lipoprotein (LDL) particles. Moreover, dyslipidaemia often coexists with a number of other atherogenic risk factors in patients with diabetes (e.g. abdominal obesity and hypertension) as part of the metabolic syndrome (insulin resistance syndrome). The metabolic syndrome is becoming ever more prevalent, with an estimated 47 million cases in the USA alone. Its association with increased cardiovascular risk is evident as a number of the clustering co-factors are CHD risk factors in their own right.
In this review, the present strategies for management of CHD reduction in patients with type 2 diabetes and new developments in this area will be discussed. Particular emphasis will be given to the current use of statins in the management of an atherogenic lipid profile, and to whether statins should be used routinely for CHD risk reduction in patients with diabetes.
Type 2 diabetes is associated with an increased risk of coronary heart disease (CHD). The association between CHD and abnormal plasma lipid levels has led current guidelines to recommend pharmacological modification of the lipid profile. Statins are particularly effective at reducing cholesterol levels, with additional benefits on other components of the lipid profile. Lipid-modifying therapy should be used routinely to reduce the risk of CHD in patients with type 2 diabetes.
In addition to microvascular complications, patients with type 2 diabetes demonstrate an increased risk towards developing coronary heart disease (CHD). Haffner et al. noted over a seven-year period that in patients with no history of CHD, the incidence of first myocardial infarction (MI) was over five times greater for patients with diabetes compared with non-diabetic controls, and was similar to the incidence for non-diabetic patients with previous MI. Deaths from cardiovascular causes were also increased in patients with diabetes, with similar rates for diabetic patients with no history of CHD and normoglycaemic patients with CHD. Therefore, all diabetes patients, irrespective of history of CHD, may be considered within the category of secondary CHD prevention, and patients with diabetes and manifestations of CHD appear to be at particularly high risk. In line with this, the most recent National Cholesterol Education Program Adult Treatment Panel guidelines (NCEP ATP III) consider diabetes as a CHD risk equivalent and suggest that patients should be treated accordingly.
Atherogenic dyslipidaemia represents a major risk factor for CHD in patients with diabetes. Diabetic dyslipidaemia may exist in the absence of raised total serum cholesterol due to an increased proportion of the more atherogenic dense low-density lipoprotein (LDL) particles. Moreover, dyslipidaemia often coexists with a number of other atherogenic risk factors in patients with diabetes (e.g. abdominal obesity and hypertension) as part of the metabolic syndrome (insulin resistance syndrome). The metabolic syndrome is becoming ever more prevalent, with an estimated 47 million cases in the USA alone. Its association with increased cardiovascular risk is evident as a number of the clustering co-factors are CHD risk factors in their own right.
In this review, the present strategies for management of CHD reduction in patients with type 2 diabetes and new developments in this area will be discussed. Particular emphasis will be given to the current use of statins in the management of an atherogenic lipid profile, and to whether statins should be used routinely for CHD risk reduction in patients with diabetes.
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