Statin therapy for the treatment of diabetic dyslipidemia

Abstract

The increasing prevalence of type 2 diabetes is a major problem for healthcare providers globally, since it is associated with serious microvascular and macrovascular complications. Although microvascular complications can be largely reduced with strict glycemic control, prevention of macrovascular disease involves a multifaceted approach that addresses all major risk factors, including dyslipidemia, hypertension, and insulin insensitivity. In particular, the treatment of diabetic dyslipidemia is a major challenge for diabetologists and cardiologists, as it is characterized by an array of lipid abnormalities. The management of diabetic dyslipidemia should initially include lifestyle approaches such as improved nutrition and weight reduction; however, the majority of patients require the addition of pharmacotherapy. Whilst insulin and/or oral hypoglycemic drugs are generally prescribed for the treatment of hyperglycemia, the addition of lipid-lowering drugs may be necessary for the control of diabetic dyslipidemia. The American Diabetes Association guidelines recommend lowering of low-density lipoprotein cholesterol (LDL-C) as a first priority. Hydroxy-methylglutaryl coenzyme A reductase inhibitors (statins) are recommended for first-line therapy in diabetic patients, since these agents are effective at reducing LDL-C levels. Whilst statins provide effective control of dyslipidemia in the majority of patients, more efficacious treatment regimens would provide greater benefit to more patients. Combination therapies may provide one solution to obtaining maximal lipid profile modifications, although the introduction of new, more efficacious agents for use as monotherapy may provide a more acceptable option, as drug combinations are often associated with poor tolerability and patient compliance.

Ezetimibe added to ongoing statin therapy improves LDL-C goal attainment and lipid profile in patients with diabetes or metabolic syndrome

“…7,9,33 Several studies have also shown that LDL-C lowering with statins in patients with DM significantly reduced the risk of cardiovascular events. 25,34 The Heart Protection Study demonstrated that, following treatment with simvastatin, the patients with diabetes without a previous history of CHD or high cholesterol benefited by a ORIGINAL ARTICLE Table 4. Baseline and percent change in lipid measures and high-sensitivity C-reactive protein in CHD or CHD risk- one-third reduction in the incidence of coronary events.…”

Clinical Manifestations of Adverse Effects of Statins, Oxidative Stress and Possible Role of Antioxidants in Prevention?

“…The secondary targets of therapy such as hypertriglyceridemia, low high density lipoprotein(HDL) cholesterol and high LDL+very low LDL and inflammation are also identified for treatment by the NCEP panel causing a further increase in the use of lipid lowering agents. The role of lipids and inflammation, in vascular disease in diabetes has been established, which would further enhance the use of statins and combination among patients with diabetic dyslipidemia [49,50]. In a randomized,controlled intervention trial, among 71patients (Intervention group) and 73 patients(Control group) of acute myocardial infarction(AMI), who were administered coenzyme Q10(120mg/day) or B vitamins for one year, half of the patients(n=36 vs 31) in both groups, received lovastatin(10-20mg/day) [51].…”

Effects of rosuvastatin on lipids, lipoproteins and apolipoproteins in the dyslipidaemia of diabetes

“…In the UK, more than 70% of individuals with Type 2 diabetes have plasma cholesterol levels higher than those recommended in guidelines for the management of patients at risk of cardiovascular disease [5]. The increased cardiovascular risk in subjects with Type 2 diabetes is attributed to the clustering of atherogenic risk factors, including hypertension, abdominal obesity and dyslipidaemia [6]. Dyslipidaemia in diabetes is characterized by elevated levels of apolipoprotein (apo)B and triglycerides (TG), small dense low‐density lipoprotein cholesterol (LDL‐C), and low levels of high‐density lipoprotein cholesterol (HDL‐C), specifically the atheroprotective HDL‐2 subtype [7].…”