Parhofer Klaus G
Medizinische Klinik IV - Grosshadern, University of Munich, Munich, Germany.
Rev Invest Clin. 2018;70(5):237-243. doi: 10.24875/RIC.18002574.
Patients with diabetes mellitus have an elevated cardiovascular risk. Lipid-lowering therapy is a successful strategy to prevent atherosclerotic events in these patients. Therefore, almost all professional societies recommend statin therapy for patients with diabetes under certain conditions. Despite this broad consensus, a number of controversial issues remain. Thus, it remains unclear in which patients the lipid parameters should be determined in the fasting state and in which postprandial values are sufficient. It is also an open issue whether all patients with diabetes should receive statin therapy and which goals should be achieved. While the benefit of statin-ezetimibe and statin-PCSK9-inhibition combinations has been shown in large outcome trials, results of outcome trials involving statins with triglyceride lowering drugs have been ambiguous. Thus, it is currently unclear which patients benefit from such combinations. Finally, the best strategy to address severe hypertriglyceridemia in patients with diabetes is unclear. This article discusses these issues and aims to provide help and information to practicing physicians taking care of patients with diabetes mellitus. (REV INVEST CLIN. 2018;70:237-43).
糖尿病患者心血管风险升高。降脂治疗是预防这些患者发生动脉粥样硬化事件的成功策略。因此，几乎所有专业学会都建议在某些情况下为糖尿病患者使用他汀类药物治疗。尽管有广泛的共识，但仍存在一些有争议的问题。因此，尚不清楚哪些患者应在空腹状态下测定血脂参数，哪些患者餐后血脂值就足够。所有糖尿病患者是否都应接受他汀类药物治疗以及应实现哪些目标也是一个未解决的问题。虽然他汀类药物与依折麦布和他汀类药物与前蛋白转化酶枯草溶菌素9（PCSK9）抑制剂联合使用的益处已在大型结局试验中得到证实，但涉及他汀类药物与降低甘油三酯药物联合使用的结局试验结果却不明确。因此，目前尚不清楚哪些患者能从这种联合治疗中获益。最后，治疗糖尿病患者严重高甘油三酯血症的最佳策略尚不清楚。本文讨论了这些问题，旨在为照顾糖尿病患者的执业医师提供帮助和信息。（《临床研究杂志》。2018年；70:237 - 43）
