Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India.
Department of Endocrinology, Centre for Diabetes, Endocrinology and Metabolism, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India.
Indian Heart J. 2024 Mar;76 Suppl 1(Suppl 1):S80-S82. doi: 10.1016/j.ihj.2023.11.002. Epub 2023 Nov 11.
Diabetes mellitus is a metabolic disorder that often predisposes to cardiovascular diseases (CVD). CVD is an important cause of morbidity and mortality in diabetes. The typical diabetic dyslipidaemia is characterized by low HDL cholesterol, high triglycerides with mildly increased or even normal LDL. This attenuated rise in LDL is due to the more atherogenic small dense LDL particles. Genetic factors, obesity, lack of physical activity, alcohol abuse, poorly controlled glucose levels are some of the common risk factors for dyslipidaemia. Non-pharmacological management of dyslipidaemia is important and includes modification in the diet, increase in physical activity and efforts to reduce weight. Statins remain the mainstay of pharmacotherapy for dyslipidaemia in diabetes. Due to the small dense LDL, even patients with diabetes who have normal LDL cholesterol, achieve reduction in cardiovascular risk with statin therapy. Those patients who do not achieve acceptable LDL reductions with statin alone can be treated with combination therapy of ezetimibe with statins. Many novel therapies have also emerged such as bempedoic acid and proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors. The targets for LDL cholesterol depend upon the patients underlying cardiovascular risk category. The use of pharmacotherapy for lowering triglycerides in patients with mild to moderate hypertriglyceridemia and diabetes is still a matter of debate. Proper management of dyslipidaemia is critical component of treatment of diabetes mellitus.
糖尿病是一种代谢紊乱疾病,常导致心血管疾病(CVD)。CVD 是糖尿病患者发病率和死亡率的重要原因。典型的糖尿病血脂异常表现为 HDL 胆固醇降低,甘油三酯升高,LDL 轻度升高甚至正常。这种 LDL 升高减弱是由于更具动脉粥样硬化的小而密 LDL 颗粒所致。遗传因素、肥胖、缺乏身体活动、酗酒、血糖控制不佳等是血脂异常的常见危险因素。血脂异常的非药物治疗很重要,包括饮食调整、增加身体活动和努力减轻体重。他汀类药物仍然是糖尿病血脂异常药物治疗的主要方法。由于小而密 LDL 的存在,即使 LDL 胆固醇正常的糖尿病患者,通过他汀类药物治疗也能降低心血管风险。对于单独使用他汀类药物不能达到可接受的 LDL 降低的患者,可以使用依折麦布联合他汀类药物进行联合治疗。许多新型疗法也已出现,如贝匹达酸和前蛋白转化酶枯草溶菌素 9(PCSK9)抑制剂。LDL 胆固醇的靶目标取决于患者的心血管风险类别。在轻中度高甘油三酯血症和糖尿病患者中使用药物治疗降低甘油三酯仍然存在争议。适当的血脂异常管理是糖尿病治疗的关键组成部分。
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