Triglycerides: Emerging Targets in Diabetes Care? Review of Moderate Hypertriglyceridemia in Diabetes

Abstract

Purpose of Review Moderate hypertriglyceridemia is exceedingly common in diabetes, and there is growing evidence that it contributes to residual cardiovascular risk in statin-optimized patients. Major fibrate trials yielded inconclusive results regarding the cardiovascular benefit of lowering triglycerides, although there was a signal for improvement among patients with high triglycerides and low high-density lipoprotein (HDL)—the “diabetic dyslipidemia” phenotype. Until recently, no trials have examined a priori the impact of triglyceride lowering in patients with diabetic dyslipidemia, who are likely among the highest cardiovascular-risk patients. Recent Findings In the recent REDUCE IT trial, omega-3 fatty acid icosapent ethyl demonstrated efficacy in lowering cardio-vascular events in patients with high triglycerides, low HDL, and statin-optimized low-density lipoprotein (LDL). The ongoing PROMINENT trial is examining the impact of pemafibrate in a similar patient population. Summary Emerging evidence suggests that lowering triglycerides may reduce residual cardiovascular risk, especially in high-risk patients with diabetic dyslipidemia.

Early detection of type 2 diabetes mellitus using machine learning-based prediction models

“…An elevated level of triglycerides is present at 60% up to 70% of diabetic patients 37 . Additionally, a recent study by Alexopoulos et al 38 recommends treatment of triglycerides as an emerging target in diabetes care. However, from a clinical perspective, questions related to the laboratory results are not convenient as a part of a screening test, since they are time consuming, expensive and difficult to obtain in some environments.…”

Legacy effect of fibrate add-on therapy in diabetic patients with dyslipidemia: a secondary analysis of the ACCORDION study

“…The findings for this prespecified subgroup with dyslipidemia must be interpreted with caution, and further larger studies in people with dyslipidemia are needed. Second, as in ACCORD, the diabetic dyslipidemia was defined in a data-driven manner, however the thresholds used are similar to other definitions of dyslipidemia [3,37]. Third, we used the investigators reported (unadjudicated) cause of death data for both trial and post-trial periods.…”

“…While other types of lipid abnormalities can be found in people with diabetes, the typical diabetic dyslipidemia (also called atherogenic dyslipidemia) is characterized by elevated triglycerides, small dense low-density lipoproteins (LDL) particles, and low levels of high-density lipoproteins (HDL) cholesterol [1]. Recommended first line measures for CVD prevention in people with diabetes who have dyslipidemia include non-drug interventions (dietary regulation, exercise, moderation of alcohol intake and weight loss) and LDL-cholesterol lowering with statin drug therapy [2,3]. The use of statins as the primary drug treatment option is supported by a large body of evidence.…”

Milk-induced hypertriglyceridaemia and acute pancreatitis after discontinuation of treatment for type 2 diabetes and hyperlipidaemia

“…As well as providing an example of the striking impact of diet on acute pancreatitis, our case exemplifies the broader phenomenon of ‘diabetic dyslipidaemia’, which is associated with a high risk of poor cardiovascular outcomes. Novel evidence suggests that reduction in triglyceride levels also significantly reduces cardiovascular risk in diabetic patients with dyslipidaemia,7 demonstrating the broader scope for risk-reduction in cardiovascular disease. The long-term management of such patients must be holistic, with emphasis on good glycaemic control and lifestyle factors key to improving outcomes.…”