Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
Curr Atheroscler Rep. 2022 Jun;24(6):471-481. doi: 10.1007/s11883-022-01020-y. Epub 2022 Apr 11.
Cardiovascular disease is the leading cause of death in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). Subclinical atherosclerotic changes are noted in youth with diabetes; therefore, timely identification and management of modifiable cardiovascular risk factors including hyperlipidemia is crucial. We review the current guidelines for hyperlipidemia screening and treatment in youth with T1D and T2D. We discuss the efficacy of non-pharmacological strategies including dietary modifications, exercise, and glycemic control and pharmacological therapy. We summarize reported rates of treatment of diabetes-related hyperlipidemia in youth.
Hyperlipidemia is prevalent among youth with T1D and T2D. Vast majority of youth with diabetes-related hyperlipidemia do not receive lipid-lowering treatments. There are several factors that contribute to suboptimal management of hyperlipidemia in youth with diabetes including limited data on efficacy and safety of statins in youth with diabetes. We propose strategies to improve hyperlipidemia management including education of providers and patients, quality improvement methods, and electronic health record alerts. Additionally, further studies are warranted to examine the safety of statins in youth with diabetes, cost-benefit analysis to aggressive screening and treatment, and long-term effect for improving cardiovascular morbidity and mortality.
心血管疾病是 1 型糖尿病（T1D）和 2 型糖尿病（T2D）患者死亡的主要原因。糖尿病患者的亚临床动脉粥样硬化变化在年轻时就已出现；因此，及时识别和管理可改变的心血管危险因素，包括血脂异常，至关重要。我们回顾了 T1D 和 T2D 青少年血脂异常筛查和治疗的现行指南。我们讨论了包括饮食调整、运动和血糖控制以及药物治疗在内的非药物策略的疗效。我们总结了报告的青少年糖尿病相关血脂异常治疗率。
血脂异常在 T1D 和 T2D 青少年中很常见。绝大多数患有糖尿病相关血脂异常的青少年并未接受降脂治疗。有几个因素导致糖尿病青少年的血脂异常管理不佳，包括关于他汀类药物在糖尿病青少年中的疗效和安全性的数据有限。我们提出了改善血脂异常管理的策略，包括对提供者和患者进行教育、质量改进方法和电子健康记录警报。此外，还需要进一步研究他汀类药物在糖尿病青少年中的安全性、积极筛查和治疗的成本效益分析，以及改善心血管发病率和死亡率的长期效果。
