O'Brien T, Nguyen T T, Zimmerman B R
Division of Endocrinology, Metabolism, and Nutrition, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clin Proc. 1998 Oct;73(10):969-76. doi: 10.4065/73.10.969.
The increased risk of coronary artery disease in subjects with diabetes mellitus can be partially explained by the lipoprotein abnormalities associated with diabetes mellitus. Hypertriglyceridemia and low levels of high-density lipoprotein are the most common lipid abnormalities. In type 1 diabetes mellitus, these abnormalities can usually be reversed with glycemic control. In contrast, in type 2 diabetes mellitus, although lipid values improve, abnormalities commonly persist even after optimal glycemic control has been achieved. Screening for dyslipidemia is recommended in subjects with diabetes mellitus. A goal of low-density lipoprotein cholesterol of less than 130 mg/dL and triglycerides lower than 200 mg/dL should be sought. Several secondary prevention trials, which included subjects with diabetes, have demonstrated the effectiveness of lowering low-density lipoprotein cholesterol in preventing death from coronary artery disease. The benefit of lowering triglycerides is less clear. Initial approaches to lowering the levels of lipids in subjects with diabetes mellitus should include glycemic control, diet, weight loss, and exercise. When goals are not met, the most common drugs used are hydroxymethylglutaryl coenzyme A reductase inhibitors or fibrates.
糖尿病患者冠状动脉疾病风险增加，部分原因可由与糖尿病相关的脂蛋白异常来解释。高甘油三酯血症和高密度脂蛋白水平降低是最常见的脂质异常情况。在1型糖尿病中，这些异常通常可通过血糖控制得到逆转。相比之下，在2型糖尿病中，尽管脂质指标有所改善，但即使在实现最佳血糖控制后，异常情况通常仍会持续。建议对糖尿病患者进行血脂异常筛查。应争取将低密度脂蛋白胆固醇目标值降至低于130mg/dL，甘油三酯降至低于200mg/dL。几项纳入了糖尿病患者的二级预防试验已证明，降低低密度脂蛋白胆固醇在预防冠状动脉疾病死亡方面是有效的。降低甘油三酯的益处尚不太明确。糖尿病患者降低血脂水平的初始方法应包括血糖控制、饮食、体重减轻和运动。当目标未达成时，最常用的药物是羟甲基戊二酰辅酶A还原酶抑制剂或贝特类药物。
