Department of Diabetes and Endocrinology, University College Hospital, 3rd Floor Central, 250 Euston Road, London NW1 2PQ, UK.
Nat Rev Cardiol. 2011 May;8(5):278-90. doi: 10.1038/nrcardio.2011.23. Epub 2011 Mar 15.
Patients with diabetes mellitus are at increased risk of cardiovascular disease (CVD). Dyslipidemia, an important component of the insulin resistance syndrome and type 2 diabetes, is strongly related to CVD risk and is open to therapeutic intervention. Statins have proved to be safe, very-well tolerated, and highly effective in reducing the levels of LDL cholesterol and apolipoprotein B. Primary and secondary CVD prevention trials have shown that use of statins leads to highly significant reductions in the incidence of major CVD events. A wealth of data on the outcomes of statin therapy is now available to guide clinical practice in the population of patients with type 2 diabetes. Statin therapy in patients with type 1 diabetes seems to have a similar benefit to that seen in patients with type 2 diabetes. However, despite statin therapy, high CVD risk persists in these populations. More-intensive statin therapy produces greater reduction in the incidence of CVD events, but a more-global approach to lipid management is likely to result in further risk reduction. After reductions in the levels of LDL cholesterol and apolipoprotein B, the next target of lipid-lowering therapy is to increase HDL-cholesterol levels, which tend to be low in patients with type 2 diabetes. The most effective HDL-cholesterol-raising agent currently available for use in clinical practice is niacin. Trials with surrogate end points have pointed to the cardiovascular benefit of adding niacin to statin therapy. Large CVD end point trials, which include many patients with diabetes, are underway to test the combination of a statin and niacin versus a statin alone.
糖尿病患者罹患心血管疾病（CVD）的风险增加。血脂异常是胰岛素抵抗综合征和 2 型糖尿病的一个重要组成部分，与 CVD 风险密切相关，并且可以进行治疗干预。他汀类药物已被证明在降低 LDL 胆固醇和载脂蛋白 B 水平方面安全、耐受性良好且非常有效。一级和二级 CVD 预防试验表明，使用他汀类药物可显著降低主要 CVD 事件的发生率。现在有大量关于他汀类药物治疗结果的数据可用于指导 2 型糖尿病患者人群的临床实践。1 型糖尿病患者的他汀类药物治疗似乎与 2 型糖尿病患者的获益相似。然而，尽管进行了他汀类药物治疗，这些人群的 CVD 风险仍然很高。更强化的他汀类药物治疗可更大程度地降低 CVD 事件的发生率，但更全面的血脂管理方法可能会进一步降低风险。在降低 LDL 胆固醇和载脂蛋白 B 水平后，降脂治疗的下一个目标是增加 HDL-胆固醇水平，而 2 型糖尿病患者的 HDL-胆固醇水平往往较低。目前可用于临床实践的最有效的升高 HDL-胆固醇的药物是烟酸。使用替代终点的试验表明，在他汀类药物治疗的基础上加用烟酸可带来心血管获益。正在进行大型 CVD 终点试验，其中包括许多糖尿病患者，以测试他汀类药物与烟酸联合应用与单独使用他汀类药物的效果。
