Warraich Haider J, Wong Nathan D, Rana Jamal S
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Curr Cardiol Rep. 2015 May;17(5):32. doi: 10.1007/s11886-015-0589-5.
Individuals with type 2 diabetes mellitus have a high residual risk of cardiovascular disease (CVD) despite maximal statin therapy and lifestyle interventions. In addition, adults with diabetes frequently exhibit the pattern of elevated triglycerides, small dense LDL, and reduced levels of high density lipoprotein cholesterol (HDL), also known as diabetic dyslipidemia. The role of combination therapy with an additional agent such as niacin, ezetimibe, fenofibrate, and n-3 fatty acids have been extensively studied with disappointing results. Review of key trials assessing benefit of combination therapy to reduce CVD risk from dyslipidemia is performed. While combination therapy frequently results in an improvement in lipid profile, to date, no consistent improvement in clinical outcomes has been observed. Therefore, current guidelines do not recommend combination therapy in individuals with diabetes, highlighting the role of intensifying statin therapy and lifestyle interventions. The recently released The IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE IT) demonstrated a small but significant improvement in clinical endpoints with addition of ezetimibe to statins in high-risk patients. Although this trial was not specifically targeted towards patients with diabetes, the results may influence the future role of a combination therapy in such a population.
尽管接受了最大剂量的他汀类药物治疗和生活方式干预，2型糖尿病患者仍有较高的心血管疾病（CVD）残留风险。此外，糖尿病成年人常表现出甘油三酯升高、小而密低密度脂蛋白以及高密度脂蛋白胆固醇（HDL）水平降低的模式，即所谓的糖尿病血脂异常。联合使用烟酸、依折麦布、非诺贝特和n-3脂肪酸等额外药物进行治疗的作用已得到广泛研究，但结果令人失望。对评估联合治疗降低血脂异常导致的CVD风险益处的关键试验进行了综述。虽然联合治疗常常能改善血脂谱，但迄今为止，尚未观察到临床结局有持续改善。因此，目前的指南不建议对糖尿病患者进行联合治疗，强调了强化他汀类药物治疗和生活方式干预的作用。最近公布的“改善转归：维妥立疗效国际试验（IMPROVE IT）”表明，在高危患者中，他汀类药物加用依折麦布可使临床终点有小幅但显著的改善。尽管该试验并非专门针对糖尿病患者，但结果可能会影响联合治疗在这类人群中的未来作用。
