Key result
Novel lipid biomarkers and targeted therapies address residual cardiovascular risk in diabetic dyslipidemia.
Why the study?
Conventional lipid profiles focusing on LDL-C may not fully capture the heterogeneous lipoprotein abnormalities and residual cardiovascular risk associated with diabetic dyslipidemia.
This narrative review highlights the need to move beyond conventional LDL-C targets in diabetic dyslipidemia by integrating particle-based biomarkers (such as ApoB, remnant cholesterol, sdLDL, and Lp(a)) and emerging therapies targeting ApoC-III and ANGPTL3 to address residual cardiovascular risk.
Answers are grounded in this paper and cite their sources.
May enhance residual risk assessment in diabetic dyslipidemia; leaves open outcome data for ApoC-III and ANGPTL3 inhibitors.
Diabetic dyslipidemia is a complex metabolic abnormality characterized by hypertriglyceridemia, reduced high-density lipoprotein cholesterol (HDL-C), qualitative abnormalities of low-density lipoprotein (LDL) particles, and accumulation of triglyceride-rich lipoproteins (TRLs) and their remnants.Although LDL cholesterol (LDL-C) remains a major therapeutic target for cardiovascular risk reduction, conventional lipid profiles may not fully capture the heterogeneous lipoprotein abnormalities associated with diabetes.Insulin resistance promotes adipose-tissue lipolysis, increases free fatty acid delivery to the liver, stimulates hepatic very-low-density lipoprotein (VLDL) production, and alters lipoprotein clearance.These processes promote the formation of small dense LDL (sdLDL), cholesterol-depleted HDL, remnant lipoproteins and other atherogenic particles.Increasing evidence indicates that apolipoprotein B (ApoB), remnant cholesterol, sdLDL, lipoprotein(a) [Lp(a)], non-HDL cholesterol and other advanced lipid parameters may provide complementary information regarding residual cardiovascular risk.Therapeutic approaches have consequently expanded from statin-based LDL-C reduction to combination therapy involving ezetimibe, PCSK9 inhibitors, bempedoic acid and selected triglyceride-lowering interventions.Emerging approaches targeting apolipoprotein C-III (ApoC-III), angiopoietin-like protein 3 (ANGPTL3), and other regulators of triglyceride-rich lipoprotein metabolism may further broaden the therapeutic landscape.This review discusses the molecular basis of diabetic dyslipidemia, limitations of conventional lipid assessment, emerging biomarkers and contemporary and investigational therapeutic strategies, emphasising the need for a more comprehensive lipoprotein-centred approach to residual cardiovascular risk in diabetes.
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A 2026 study conducted a review in Diabetic dyslipidemia. Lipid-lowering therapies and emerging RNA-based therapeutics (statins, ezetimibe, PCSK9 inhibitors, bempedoic acid, icosapent ethyl, ApoC-III and ANGPTL3 inhibitors) was evaluated. Advanced lipid biomarkers like ApoB, remnant cholesterol, sdLDL, and Lp(a), alongside emerging therapies targeting ApoC-III and ANGPTL3, address residual cardiovascular risk in diabetic dyslipidemia.
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