Departments of Medicine and Biochemistry and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Departments of Medicine and Biochemistry and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Can J Diabetes. 2020 Feb;44(1):53-60. doi: 10.1016/j.jcjd.2019.07.003. Epub 2019 Jul 12.
Lipid abnormalities beyond elevated low-density lipoprotein (LDL) cholesterol contribute to increased risk of atherosclerotic cardiovascular disease (ASCVD) in type 2 diabetes. We searched for English language randomized controlled trials of lipid-lowering therapies primarily since 2012 that included patients with diabetes. Diet and lifestyle advice are always a starting point for ASCVD prevention in diabetes. After almost 30 years of widespread clinical use in diabetes, statin treatment to reduce LDL cholesterol remains the cornerstone of drug therapy to prevent ASCVD. Ezetimibe appears to be particularly beneficial for high-risk statin-treated patients with diabetes. Similarly, currently available proprotein convertase subtilisin kexin type 9 inhibitors-alirocumab and evolocumab-both reduce ASCVD risk in statin-treated patients with diabetes. High-dose icosapent ethyl is another worthwhile add-on treatment, especially in statin-treated patients with diabetes in whom triglyceride levels remain elevated. Fibrates might reduce ASCVD risk in patients with diabetes with high triglyceride and low high-density lipoprotein cholesterol; however, fibrates are more strongly recommended for prophylaxis of pancreatitis in patients with severe hypertriglyceridemia and may also slow progression of diabetic retinopathy. Several existing and newer drug treatments reduce ASCVD risk through LDL cholesterol and/or triglyceride reduction in patients with diabetes. Novel approaches using antisense oligonucleotides and monoclonal antibodies may provide potential future therapies for diabetic dyslipidemia.
除了升高的低密度脂蛋白 (LDL) 胆固醇外，脂质异常也会增加 2 型糖尿病患者发生动脉粥样硬化性心血管疾病 (ASCVD) 的风险。我们主要检索了自 2012 年以来发表的关于降脂治疗的英语随机对照试验，这些试验纳入了糖尿病患者。饮食和生活方式建议始终是糖尿病 ASCVD 预防的起点。在他汀类药物治疗降低 LDL 胆固醇广泛应用于糖尿病近 30 年后，它仍然是预防 ASCVD 的药物治疗基石。依折麦布似乎对糖尿病高危他汀类药物治疗患者特别有益。同样，目前可用的前蛋白转化酶枯草溶菌素 9 抑制剂——阿利西尤单抗和依洛尤单抗——均可降低糖尿病他汀类药物治疗患者的 ASCVD 风险。高剂量依折麦布乙酯是另一种值得添加的治疗药物，尤其适用于他汀类药物治疗后仍存在甘油三酯升高的糖尿病患者。贝特类药物可能降低伴有高甘油三酯和低高密度脂蛋白胆固醇的糖尿病患者的 ASCVD 风险；然而，对于严重高甘油三酯血症的患者，更强烈推荐使用贝特类药物预防胰腺炎，并且其也可能减缓糖尿病性视网膜病变的进展。几种现有的和新型药物治疗通过降低 LDL 胆固醇和/或甘油三酯降低糖尿病患者的 ASCVD 风险。使用反义寡核苷酸和单克隆抗体的新方法可能为糖尿病性血脂异常提供潜在的未来治疗方法。
