Carmena Rafael, Ascaso Juan F
Servicio de Endocrinología y Nutrición, Departamento de Medicina, Hospital Clínico Universitario, Universidad de Valencia, Valencia, España.
Med Clin (Barc). 2010 Apr 3;134(9):406-11. doi: 10.1016/j.medcli.2009.10.010. Epub 2010 Jan 4.
Diabetic dyslipidemia, characterized by the lipid triad (elevated plasma triglycerides, low HDL cholesterol and predominance of small, dense LDL particles), is a significant contributor to the elevated cardiovascular risk of type 2 diabetic patients. Statin monotherapy has shown, in different prospective trials, significant reductions in cardiovascular events and mortality. However, the residual risk in these subjects remains elevated, probably due to the incomplete control of diabetic dyslipidemia. In this review we discuss the global therapeutic approach, underlying the need of combining statins with agents that more effective in reducing triglycerides and elevating HDL cholesterol, even in subjects whose LDL cholesterol values are at target. Available data supports that such combinations contribute to normalize the lipid profile with possible beneficial effects on the cardiovascular risk. Ongoing clinical trials, using different combinations and focusing on cardiovascular morbidity and mortality are also discussed. In our opinion, the future treatment of diabetic dyslipidemia will include the combination of statins and other hypolipidemic agents.
糖尿病血脂异常以脂质三联征（血浆甘油三酯升高、高密度脂蛋白胆固醇降低以及小而密的低密度脂蛋白颗粒占主导）为特征，是导致2型糖尿病患者心血管风险升高的重要因素。在不同的前瞻性试验中，他汀类药物单药治疗已显示出心血管事件和死亡率显著降低。然而，这些患者的残余风险仍然较高，这可能是由于糖尿病血脂异常未得到完全控制所致。在本综述中，我们讨论了整体治疗方法，强调了即使在低密度脂蛋白胆固醇值达标的患者中，也需要将他汀类药物与更有效地降低甘油三酯和升高高密度脂蛋白胆固醇的药物联合使用。现有数据支持，这种联合用药有助于使血脂谱正常化，并可能对心血管风险产生有益影响。我们还讨论了正在进行的、使用不同联合用药方案并聚焦于心血管发病率和死亡率的临床试验。我们认为，糖尿病血脂异常的未来治疗将包括他汀类药物与其他降脂药物的联合使用。
