Division of Endocrinology & Nutrition, Cliniques universitaires St-Luc and Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Jean Verdier Hospital, Paris 13 University, Bondy, France.
Curr Opin Endocrinol Diabetes Obes. 2018 Apr;25(2):118-129. doi: 10.1097/MED.0000000000000398.
The aim of this review is to describe in diabetic patients the determinants underlying atherogenic dyslipidemia, a complex dyslipidemia defined as the coexistence of fasting hypertriglyceridemia and low high-density lipoprotein cholesterol level. Atherogenic dyslipidemia is often comorbid with hyperglycemia in patients with the common form of type 2 diabetes mellitus (T2DM), namely that associated with obesity, insulin resistance, hyperinsulinemia and the metabolic syndrome phenotype.
The role of triglyceride-rich lipoproteins, both fasting and nonfasting, is increasingly considered as a direct driver of atherosclerosis in diabetic patients, even in those receiving best standards of care, including low-density lipoprotein cholesterol level adequately controlled by statins and/or ezetimibe. The residual cardiovascular risk related to atherogenic dyslipidemia in T2DM patients can be inferred from subgroup analysis of diabetic patients within landmark lipid-lowering trials, or from T2DM-only trials, such as Fenofibrate Intervention and Event Lowering in Diabetes study or Action to Control Cardiovascular Risk in Diabetes-Lipid trial.
The presence of atherogenic dyslipidemia markedly increases cardiovascular risk, and there is evidence that part of the residual cardiovascular risk in T2DM can be safely and effectively reduced by fibrates. Ongoing trials will determine whether new classes of drugs or dietary intervention targeting hypertriglyceridemia (such as n-3 fatty acids or SPPARMα) will reduce macro and microvascular residual risk in T2DM patients with atherogenic dyslipidemia at inclusion.
本综述旨在描述糖尿病患者致动脉粥样硬化性血脂异常的决定因素，这种复杂的血脂异常定义为空腹高甘油三酯血症和低高密度脂蛋白胆固醇水平并存。致动脉粥样硬化性血脂异常常与 2 型糖尿病（T2DM）患者的高血糖并存，即与肥胖、胰岛素抵抗、高胰岛素血症和代谢综合征表型相关。
富含甘油三酯的脂蛋白（无论是空腹还是非空腹）的作用越来越被认为是糖尿病患者动脉粥样硬化的直接驱动因素，即使是那些接受最佳标准治疗的患者，包括他汀类药物和/或依折麦布充分控制的低密度脂蛋白胆固醇水平。在降脂试验的糖尿病亚组分析中，或在仅针对 T2DM 的试验中，如非诺贝特干预和糖尿病事件降低研究或心血管风险控制行动-糖尿病-脂质试验中，可以推断出 T2DM 患者致动脉粥样硬化性血脂异常相关的残余心血管风险。
致动脉粥样硬化性血脂异常的存在显著增加了心血管风险，有证据表明，在 T2DM 患者中，部分残余心血管风险可以通过贝特类药物安全有效地降低。正在进行的试验将确定针对高甘油三酯血症的新型药物或饮食干预（如 n-3 脂肪酸或 SPPARMα）是否可以降低纳入时存在致动脉粥样硬化性血脂异常的 T2DM 患者的大血管和微血管残余风险。
