Diabetes associated dyslipidemia: Management
By Ramachandran Vadivelan, Dipanjan Mandal, Umasankar Payyavulla, Dhanabal Palaniswamy, Kannan Elango and Suresh Bhojraj
By the year 2030, it is assumed that there will be more than 300 million type 2 diabetes sufferers worldwide. Diabetes is a serious vascular disease with poor prognosis, and not only a disease characterized by elevated blood glucose . One important cardiovascular risk factor in type 2 diabetic people is dyslipidaemia. This comprises low HDL-cholesterol, high serum VLDL-triglycerides, and a preponderance of small, dense LDL. Even slight elevations of LDL-cholesterol in type 2 diabetes are associated with a substantial increase in cardiovascular risk. The composition of lipid particles in diabetic dyslipidaemia is more atherogenic than in dyslipidaemia in general. Atherosclerosis is a major complication of diabetes responsible for the increased morbidity and mortality. Lowering of LDL-cholesterol is a very attractive target of lipid modifying therapy, dyslipidaemia therapies are efficacious for both LDL-cholesterol reduction and raising HDL-cholesterol might offer more improvements in coronary heart disease in type 2 diabetic people. Statins are first-line pharmacotherapy for dyslipidaemia and can also improve HDL-cholesterol levels. Combining a fibrate or niacin with statin therapy raises HDL-cholesterol more than a statin alone but might be associated with reduced tolerability and increased adverse reactions. Several new therapeutic approaches to raising HDL-cholesterol are in development, including an HDL mimetic and inhibitors of cholesteryl ester transfer protein. Dyslipidaemia therapies are efficacious for both LDL-cholesterol reduction and raising HDL-cholesterol might offer further improvements in coronary heart disease (CHD) risk reduction.
Key words: Type 2 Diabetes mellitus, dyslipidaemia, coronary heart disease, management.