Atlanta Veterans Affairs Medical Center, Emory University, Atlanta, GA, USA.
J Clin Lipidol. 2008 Oct;2(5):335-42. doi: 10.1016/j.jacl.2008.08.444. Epub 2008 Aug 22.
Patients with diabetes or metabolic syndrome frequently have higher triglycerides, lower high-density lipoprotein (HDL) cholesterol, and more particles containing apolipoprotein B (ApoB); this combination contributes significantly to their cardiovascular risk. Optimal management of dyslipidemia and increased atherosclerotic risk requires a fundamental understanding of diabetic dyslipidemia, the clinical evidence for different interventional strategies, and the potential benefit of achieving therapeutic targets. For this review, we considered guidelines, recent reviews, and clinical trial results. The features of dyslipidemia in type 2 diabetes and the metabolic syndrome are linked metabolically and are related to central adiposity and insulin resistance. Levels of ApoB and HDL cholesterol are particularly important markers of risk. Guidelines broadly agree that low-density lipoprotein (LDL) cholesterol should be reduced below population average levels. Additional or secondary strategies in patients with diabetes or the metabolic syndrome are to decrease non-HDL cholesterol, ApoB and/or LDL particle concentration, to increase HDL cholesterol, and to reduce triglycerides. Lifestyle changes and statins are the bedrock of treatment, although second-line treatment using fibrates or niacin will likely benefit many patients with residual risk. Ezetimibe, too, has a favorable effect on lipid profile and inflammatory biomarkers of risk. Dyslipidemia in type 2 diabetes and metabolic syndrome has a distinct profile, suggesting the need for a tailored therapy that targets the key features of lowered HDL cholesterol and raised triglycerides, in addition to the primary antiatherogenic strategy of lowering ApoB-containing lipoproteins, such as LDL. With the prominent failure of some recent intervention trials, new therapeutic strategies-particularly safe and effective means to raise HDL-are needed to manage dyslipidemia in this high-risk population.
患有糖尿病或代谢综合征的患者通常具有更高的甘油三酯、更低的高密度脂蛋白（HDL）胆固醇和更多含有载脂蛋白 B（ApoB）的颗粒；这种组合极大地增加了他们的心血管风险。要优化血脂异常和增加的动脉粥样硬化风险的管理，需要对糖尿病血脂异常有基本的了解、不同干预策略的临床证据，以及实现治疗目标的潜在益处。为此综述，我们考虑了指南、最新综述和临床试验结果。2 型糖尿病和代谢综合征的血脂异常特征在代谢上相互关联，与中心性肥胖和胰岛素抵抗有关。ApoB 和 HDL 胆固醇水平是特别重要的风险标志物。指南普遍认为，应将 LDL 胆固醇降低至低于人群平均水平。对于糖尿病或代谢综合征患者，额外或二级策略是降低非 HDL 胆固醇、ApoB 和/或 LDL 颗粒浓度，增加 HDL 胆固醇，降低甘油三酯。生活方式改变和他汀类药物是治疗的基础，尽管使用贝特类或烟酸的二线治疗可能会使许多有残余风险的患者受益。依折麦布也对血脂谱和风险的炎症生物标志物有有利影响。2 型糖尿病和代谢综合征的血脂异常具有独特的特征，这表明需要一种针对性的治疗方法，除了降低载脂蛋白 B 含量脂蛋白（如 LDL）的主要抗动脉粥样硬化策略外，还需要针对降低 HDL 胆固醇和升高甘油三酯的关键特征。由于最近一些干预试验的突出失败，需要新的治疗策略——特别是安全有效的提高 HDL 的方法，来管理这一高危人群的血脂异常。
