Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center and Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
Endocr Pract. 2009 Sep-Oct;15(6):641-52. doi: 10.4158/EP09190.RA.
To review the pathophysiologic basis for the classic phenotype associated with diabetic dyslipidemia, discuss recent advances in lipid and lipoprotein testing for risk assessment and lipid therapy monitoring, and summarize a systematic approach to the clinical management of diabetic dyslipidemia.
We review the pertinent literature, including treatment guidelines and results of major clinical trials, and discuss the effectiveness of various pharmacologic interventions for management of lipid levels in patients with diabetes.
The incidence and prevalence of type 2 diabetes mellitus continue to escalate globally at alarming rates. Diabetes predisposes to multiple microvascular and macrovascular complications, including cardiovascular disease, the number 1 cause of mortality in the United States. The third report of the National Cholesterol Education Program Adult Treatment Panel in 2001 identified diabetes as a coronary heart disease (CHD) risk equivalent, in light of the evidence that CHD risk in persons with diabetes is similar to that of nondiabetic persons with established CHD. Diabetic dyslipidemia is characterized by a constellation of lipid derangements-hypertriglyceridemia, a low concentration of high-density lipoprotein cholesterol (HDL-C), and a high concentration of small, dense low-density lipoprotein (LDL) particles-that accelerate the progression of atherosclerotic disease and the development of atherothrombotic events.
Statin trials have demonstrated significant reductions in morbidity and mortality from cardiovascular diseases, including in patients with diabetes. Nevertheless, many patients who achieve their LDL cholesterol (LDL-C) goal still have residual CHD risk. Diabetic dyslipidemia contributes to this residual risk because of the increased concentration of atherogenic apolipoprotein B-containing lipoproteins that can persist despite normalized LDL-C levels and low HDL-C levels. Recent clinical trials emphasize the importance of intensive lipid lowering to achieve recommended goals for LDL-C, non-HDL-C, and apolipoprotein B.
回顾与糖尿病血脂异常相关的经典表型的病理生理基础，讨论脂质和脂蛋白检测在风险评估和脂质治疗监测方面的最新进展，并总结糖尿病血脂异常的临床管理系统方法。
我们回顾了相关文献，包括治疗指南和主要临床试验结果，并讨论了各种药物干预措施在管理糖尿病患者血脂水平方面的有效性。
全球 2 型糖尿病的发病率和患病率仍以惊人的速度持续上升。糖尿病易患多种微血管和大血管并发症，包括心血管疾病，这是美国头号死亡原因。2001 年国家胆固醇教育计划成人治疗专家组第三次报告指出，鉴于糖尿病患者的冠心病风险与已确诊冠心病的非糖尿病患者相似，糖尿病是冠心病的等效风险因素。糖尿病血脂异常的特征是一系列脂质异常——高甘油三酯血症、高密度脂蛋白胆固醇（HDL-C）浓度低和小而密的低密度脂蛋白（LDL）颗粒浓度高，这些都会加速动脉粥样硬化疾病的进展和动脉血栓形成事件的发生。
他汀类药物试验已经证明了心血管疾病发病率和死亡率的显著降低，包括在糖尿病患者中。然而，许多达到 LDL 胆固醇（LDL-C）目标的患者仍存在残余的 CHD 风险。糖尿病血脂异常导致了这种残余风险，因为即使 LDL-C 水平正常且 HDL-C 水平较低，致动脉粥样硬化的载脂蛋白 B 含量较高的脂蛋白的浓度仍会增加。最近的临床试验强调了通过强化降脂达到 LDL-C、非 HDL-C 和载脂蛋白 B 的推荐目标的重要性。
Zotero 插件