Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Curr Cardiol Rep. 2021 Mar 2;23(4):26. doi: 10.1007/s11886-021-01455-w.
Type 2 diabetes mellitus is widespread throughout the world and is a powerful risk factor for the development of atherosclerotic cardiovascular disease (ASCVD). This manuscript explored the mechanisms underlying dyslipidemia in type 2 diabetes as well as currently available treatment options and guideline recommendations.
Type 2 diabetes is associated with a characteristic pattern of dyslipidemia, often termed diabetic dyslipidemia. Patients with type 2 diabetes often present with low HDL levels, elevated levels of small dense LDL particles, and elevated triglyceride levels. LDL lowering is the cornerstone of managing diabetic dyslipidemia, and statins are the mainstay of therapy. The cholesterol absorption inhibitor ezetimibe and PCSK9 inhibitors have also been shown to lower risk in patients with diabetes. Recently, the eicosapentaenoic (EPA) only n-3 fatty acid, icosapent ethyl, has also shown benefit for cardiovascular risk reduction in patients with diabetes. To date, no agents targeting HDL increase have shown cardiovascular benefit in patients on background statin therapy. Diabetic dyslipidemia is significant cardiovascular disease risk factor, and LDL-lowering therapy with statins, PCSK9 inhibitors, and ezetimibe continues to be mainstay therapy to reduce cardiovascular risk. Future studies targeting low HDL and high triglycerides levels associated with type 2 diabetes could provide additional novel therapies to manage diabetic dyslipidemia.
2 型糖尿病在全球范围内广泛存在，是动脉粥样硬化性心血管疾病（ASCVD）发展的一个强有力的危险因素。本文探讨了 2 型糖尿病患者血脂异常的发病机制，以及目前可用的治疗选择和指南建议。
2 型糖尿病与特征性的血脂异常模式有关，通常称为糖尿病血脂异常。2 型糖尿病患者常伴有 HDL 水平降低、小而密 LDL 颗粒水平升高和甘油三酯水平升高。降低 LDL 是治疗糖尿病血脂异常的基石，他汀类药物是主要的治疗方法。胆固醇吸收抑制剂依折麦布和 PCSK9 抑制剂也已被证明可降低糖尿病患者的风险。最近，只有二十碳五烯酸（EPA）的 n-3 脂肪酸依替莫司乙酯也显示出对糖尿病患者心血管风险降低的益处。迄今为止，在背景他汀类药物治疗的患者中，没有任何针对 HDL 增加的药物显示出对心血管的益处。糖尿病血脂异常是心血管疾病的一个重要危险因素，他汀类药物、PCSK9 抑制剂和依折麦布的 LDL 降低治疗仍然是降低心血管风险的主要治疗方法。未来针对与 2 型糖尿病相关的低 HDL 和高甘油三酯水平的研究可能会提供额外的新型治疗方法来治疗糖尿病血脂异常。
