Dyslipoproteinaemia: Important Concern in Type 2 Diabetes

Abstract

Dyslipoproteinaemia, also known as dyslipidaemia, occurs in more than 70% of people with diabetes and is a significant risk factor for atherosclerotic cardiovascular disease (ASCVD) associated with obesity, hypertension, and poor glycaemic control. The prevalence of diabetes worldwide is increasing, and so is the death rate in people with diabetes. The causes of dyslipoproteinaemia are divided into primary (genetic) or secondary, which are diagnosed from history (diabetes, obesity, endocrine disorders, and chronic kidney disease). The pattern of dyslipoproteinaemia in diabetes typically consists of increased levels of fasting and post-prandial triacylglycerols (TAGs), Low Dense Lipoprotein-C (LDL-C), non-HDL-C, small LDL particles and Apo-B and lower levels of non-atherogenic HDL-C and ApoA1. Treating dyslipoproteinaemia includes patients’ risk stratification and targeting those at high risk. It consists of lifestyle modification, statins, cholesterol absorption inhibitors (ezetimibe), drugs that increase HDL and reduce LDL (niacin, fibrates), triglycerides (Omega-3) and bile acid sequestrants. Proprotein convertase subtilisin–kexin type 9 inhibitors reduce LDL by 60–80%, ApoB by 50% and Lp (a) by 25% and should be considered in all people with diabetes with other risk factors and with coexisting primary dyslipoproteinaemia before developing ASCVD as well as those with established ASCVD.