Colagiuri Stephen, Best James
Department of Endocrinology, Diabetes and Metabolism, Prince of Wales Hospital, Sydney, New South Wales.
Curr Opin Lipidol. 2002 Dec;13(6):617-23. doi: 10.1097/00041433-200212000-00004.
The risk of cardiovascular disease is markedly increased in people with type 2 diabetes. There is abundant epidemiological and clinical trial evidence that lipid abnormalities play a major role in the pathogenesis of atherosclerotic vascular disease in diabetes. Although the benefits of lipid-lowering therapy are well established in people without diabetes, the evidence in people with diabetes is not as well established.
Recent population studies of lipid-lowering therapy and cardiovascular disease outcomes that included people with diabetes and performed a separate subgroup analysis were reviewed. Lipid lowering with statins and fibrates is effective in improving cardiovascular disease outcomes in diabetes, and their effectiveness is similar to that in the non-diabetic population. This effect is well established in secondary prevention and is accumulating for primary prevention.
Individuals with diabetes require aggressive management of dyslipidaemia as part of an overall management strategy to reduce the risk of cardiovascular disease. Individuals with a previous cardiovascular disease event should be on lipid-lowering therapy, whereas in those who have not had a previous cardiovascular disease event, the decision to use lipid-lowering therapy should be based on lipid levels and the overall risk of a future event. The results of large studies that are currently in progress specifically in people with diabetes should resolve outstanding questions in relation to lipid-lowering therapy in diabetes.
2型糖尿病患者心血管疾病风险显著增加。有大量流行病学和临床试验证据表明，脂质异常在糖尿病动脉粥样硬化性血管疾病的发病机制中起主要作用。虽然降脂治疗在非糖尿病患者中的益处已得到充分证实，但在糖尿病患者中的证据尚不充分。
对近期包括糖尿病患者并进行单独亚组分析的降脂治疗与心血管疾病结局的人群研究进行了综述。使用他汀类药物和贝特类药物降脂可有效改善糖尿病患者的心血管疾病结局，其有效性与非糖尿病人群相似。这种效果在二级预防中已得到充分证实，在一级预防中也越来越多。
糖尿病患者需要积极管理血脂异常，作为降低心血管疾病风险的整体管理策略的一部分。既往有心血管疾病事件的个体应接受降脂治疗，而对于既往无心血管疾病事件的个体，使用降脂治疗的决定应基于血脂水平和未来事件的总体风险。目前正在进行的专门针对糖尿病患者的大型研究结果应能解决与糖尿病降脂治疗相关的悬而未决的问题。
