Atherogenic dyslipidemia and combination pharmacotherapy in diabetes: recent clinical trials.
Atherogenic dyslipidemia and combination pharmacotherapy in diabetes: recent clinical trials.
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DOI：
10.1900/rds.2013.10.191
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发表时间：
2013-06-01
期刊：
影响因子：
--
通讯作者：
Watts, Gerald F
中科院分区：
文献类型：
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作者：
Hamilton, Sandra J;Watts, Gerald F
2型糖尿病（T2 D）患者患心血管疾病（CVD）的风险显著增加。血脂异常是T2 D患者的常见风险因素，也是CVD的强预测因子。尽管他汀类药物可降低2型糖尿病患者CVD的发生率，但尽管达到最佳或接近最佳的血浆低密度脂蛋白（LDL）胆固醇浓度，残余心血管风险仍然很高。这可能部分是由于未纠正的致动脉粥样硬化性血脂异常。高胆固醇血症是糖尿病血脂异常的驱动力，由肝脏过度生产和/或富含胆固醇的脂蛋白的清除延迟引起。在接受他汀类药物治疗以达到LDL-胆固醇目标的患者中，可能需要添加依折麦布、非诺贝特、烟酸或n-3脂肪酸乙酯，以纠正持续性致动脉粥样硬化性血脂异常。描述最佳实践的临床试验证据是有限的，但最近的数据支持在他汀类药物中加入非诺贝特的策略，并表明在血脂异常患者和糖尿病视网膜病变的改善中有特定的益处。然而，根据最近的一项临床试验结果，烟酸不应该被添加到他汀类药物中，用于高密度脂蛋白胆固醇低和LDL胆固醇控制良好的个体。需要进一步证据来支持依折麦布和n-3脂肪酸在他汀类药物治疗的T2 D患者中治疗残余CVD风险的作用。
Patients with type 2 diabetes (T2D) are at a markedly increased risk of cardiovascular disease (CVD). Dyslipidemia is a common risk factor and a strong predictor of CVD in T2D patients. Although statins decrease the incidence of CVD in T2D, residual cardiovascular risk remains high despite the achievement of optimal or near-optimal plasma low-density lipoprotein (LDL) cholesterol concentrations. This may, in part, be due to uncorrected atherogenic dyslipidemia. Hypertriglyceridemia, the driving force behind diabetic dyslipidemia, results from hepatic overproduction and/or delayed clearance of triglyceride-rich lipoproteins. In patients treated with a statin to LDL-cholesterol goals, the addition of ezetimibe, fenofibrate, niacin, or n-3 fatty acid ethyl esters may be required to correct the persistent atherogenic dyslipidemia. Clinical trial evidence describing best practice is limited, but recent data supports the strategy of adding fenofibrate to a statin, and suggests specific benefits in dyslipidemic patients and in the improvement of diabetic retinopathy. However, based on results from a recent clinical trial, niacin should not be added to a statin in individuals with low high-density lipoprotein cholesterol and very well controlled LDL-cholesterol. Further evidence is required to support the role of ezetimibe and n-3 fatty acids in treating residual CVD risk in statin-treated T2D patients.