An overview on management of diabetic dyslipidemia

Type 2 diabetes mellitus (DM) has recently been described as “coronary risk equivalent”. Lipoprotein metabolism disorder in type 2 DM is known as diabetic dyslipidemia. Dyslipidemia contributes to a substantial percentage in cardiovascular mortality and morbidity in diabetic patients. National Cholesterol Education Program (NCEP) and American Diabetic Association (ADA) have provided recent guidelines for early diagnostic and therapeutic approaches to contain this health hazard. Diabetic patients tend to have higher serum levels of triglycerides (TGs), lower high-density lipoprotein cholesterol (HDL-C), and similar serum values for low-density lipoprotein cholesterol (LDL-C) when compared with non-diabetic patients. However, diabetic patients tend to have a higher concentration of smaller and denser LDL particles, which are associated with higher coronary heart disease (CHD) risk. Current recommendations are for a LDL-C goal of less than 100 mg/dl (an option of less than 70 mg/dl in very high-risk patients), a HDL-C goal greater than 40 mg/dl for men and greater than 50 mg/dl for women, and a triglyceride goal less than 150 mg/dl. Non-pharmacologic interventions (diet and exercise) are firstline therapies and are adjuvant to the pharmacologic therapy when necessary. Reduction in serum LDL levels will reduce the circulating levels of smaller and denser LDL particles. Thus lowering LDL-C level is the first priority in treating diabetic dyslipidemia. Statins are the first drug of choice, followed by resins, ezetimibe, fenofibrate, niacin and others. If a single agent is inadequate to achieve lipid goals, combinations of the preceding drugs may be used.