Department of Cardiovascular Science, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy.
Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy.
Curr Diab Rep. 2018 Oct 29;18(12):138. doi: 10.1007/s11892-018-1117-y.
To summarize available evidence regarding lipid-lowering interventions for the prevention of cardiovascular disease in patients with diabetes.
Statins and non-statin therapies that act through upregulation of LDL receptor expression are associated with similar cardiovascular risk reduction per decrease in LDL cholesterol. In subjects with diabetes, with or without established cardiovascular disease, each 39 mg/dl reduction in LDL cholesterol observed with statins is associated with a 21% relative reduction in the risk of major coronary events at 5 years. Statins remain the first-line lipid-lowering agents for the management of dyslipidemia in individuals with diabetes; however, the addition of non-statin therapies to lower LDL cholesterol, such as ezetimibe and PCSK-9 inhibitors, to maximally tolerated statin therapy is recommended in patients with atherosclerotic cardiovascular disease and baseline LDL cholesterol over 70 mg/dl. Recent data support even lower LDL cholesterol targets (< 55 mg/dl) to further reduce the risk of cardiovascular events especially in subjects with diabetes and documented cardiovascular disease.
总结降脂干预预防糖尿病患者心血管疾病的现有证据。
通过上调 LDL 受体表达起作用的他汀类药物和非他汀类药物治疗与 LDL 胆固醇降低相关的心血管风险降低相似。在有或没有已确诊心血管疾病的糖尿病患者中，他汀类药物使 LDL 胆固醇降低 39mg/dl，与 5 年内主要冠状动脉事件风险降低 21%相关。他汀类药物仍然是糖尿病患者血脂异常管理的一线降脂药物；然而，建议在有动脉粥样硬化性心血管疾病和基线 LDL 胆固醇超过 70mg/dl 的患者中，将非他汀类药物治疗（如依折麦布和 PCSK9 抑制剂）添加到最大耐受剂量的他汀类药物治疗中，以最大程度降低 LDL 胆固醇。最近的数据支持更低的 LDL 胆固醇目标（<55mg/dl），以进一步降低心血管事件的风险，尤其是在有糖尿病和已确诊心血管疾病的患者中。
