Rational Therapy of Mixed Dyslipidaemia in a Patient with Diabetes
Diabetic dyslipidaemia refers to the triad of elevated levels of triglycerides and small, dense LDL-C particles and low levels of HDL-C. These lipid abnormalities are largely responsible for the increased risk of cardiovascular complications in patients with diabetes. This case study outlines a rational approach to the treatment of each of these lipid abnormalities and emphasizes the importance of both lowering the LDL-C and raising the HDL-C in high-risk individuals. Combination drug therapy will often be necessary to achieve treatment goals in these patients.
Atherosclerosis is the most commonly occurring complication of diabetes mellitus. The risk of death from CHD is two to four times higher among individuals with diabetes than among individuals without diabetes. Several studies have shown that the risk of atherosclerotic events, including fatal and non-fatal MI, stroke, and congestive heart failure, is as great for diabetics with out CHD as it is for non-diabetics with established CHD. It has also been reported that patients with type 2 diabetes experience worse clinical outcomes after MI and congestive heart failure than do non-diabetics. Currently, it is estimated that two thirds to three quarters of the 17 million adult Americans with diabetes will die of some form of cardiovascular disease. Thus it is critical to assess all cardiovascular risk factors in patients with diabetes and initiate therapy to reduce their global risk of heart disease. A range of guidelines exist with recommended targets for parameters of cardiovascular risk.
The accelerated atherosclerosis typically linked to type 2 diabetes is associated with a characteristic lipoprotein profile termed "atherogenic dyslipidaemia." This condition is defined by the triad of high TG, low HDL-C, and the presence of small, dense LDL particles. Despite the availability of effective lipid-lowering agents, consensus guidelines for CHD risk reduction are not being widely followed, especially when treating high-risk patients. In patients with diabetic dyslipidaemia, lipid-lowering agents are used less frequently, and recommended treatment goals are attained less successfully, than in non-diabetic patients. This case study will illustrate my treatment approach to a high-risk patient with diabetes and atherogenic dyslipidaemia.
Abstract and Introduction
Abstract
Diabetic dyslipidaemia refers to the triad of elevated levels of triglycerides and small, dense LDL-C particles and low levels of HDL-C. These lipid abnormalities are largely responsible for the increased risk of cardiovascular complications in patients with diabetes. This case study outlines a rational approach to the treatment of each of these lipid abnormalities and emphasizes the importance of both lowering the LDL-C and raising the HDL-C in high-risk individuals. Combination drug therapy will often be necessary to achieve treatment goals in these patients.
Introduction
Atherosclerosis is the most commonly occurring complication of diabetes mellitus. The risk of death from CHD is two to four times higher among individuals with diabetes than among individuals without diabetes. Several studies have shown that the risk of atherosclerotic events, including fatal and non-fatal MI, stroke, and congestive heart failure, is as great for diabetics with out CHD as it is for non-diabetics with established CHD. It has also been reported that patients with type 2 diabetes experience worse clinical outcomes after MI and congestive heart failure than do non-diabetics. Currently, it is estimated that two thirds to three quarters of the 17 million adult Americans with diabetes will die of some form of cardiovascular disease. Thus it is critical to assess all cardiovascular risk factors in patients with diabetes and initiate therapy to reduce their global risk of heart disease. A range of guidelines exist with recommended targets for parameters of cardiovascular risk.
The accelerated atherosclerosis typically linked to type 2 diabetes is associated with a characteristic lipoprotein profile termed "atherogenic dyslipidaemia." This condition is defined by the triad of high TG, low HDL-C, and the presence of small, dense LDL particles. Despite the availability of effective lipid-lowering agents, consensus guidelines for CHD risk reduction are not being widely followed, especially when treating high-risk patients. In patients with diabetic dyslipidaemia, lipid-lowering agents are used less frequently, and recommended treatment goals are attained less successfully, than in non-diabetic patients. This case study will illustrate my treatment approach to a high-risk patient with diabetes and atherogenic dyslipidaemia.
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