Lipid Disorders in Diabetes Mellitus and Current Management

Garry   X.   Shen

Abstract

Lipid disorders are common in diabetes mellitus (DM), and play crucial roles in the development of diabetic cardiovascular complications. Diabetic dyslipidemia is characterized by hypertriglyceridemia, increased levels of very low density lipoproteins (VLDL), small dense low density lipoprotein (LDL), and decreased levels of high density lipoprotein (HDL)-cholesterol. The activity of lipoprotein lipase is reduced in diabetic patients, which attenuates the lipolysis of triglyceride-rich lipoproteins and the uptake of free fatty acids. The increased uptake of triglycerides in liver promotes the production of VLDL. Hypertriglyceridemia promotes the exchange of cholesteryl ester from HDL to VLDL or LDL for triglycerides. Obesity or nephropathy deteriorates the dyslipidemia in DM patients. The initial management of lipid disorders in diabetic patients without cardiovascular disease is lifestyle intervention and glucose control. The abnormalities in the metabolism of LDL or HDL in diabetic patients often require pharmacological intervention. Target of LDL-cholesterol (LDL-c) is more restrict in diabetic patients than in non-diabetic subjects. Treatment with HMG-CoA reductase inhibitors (statins) effectively reduces LDL-c and cardiac events, and that was associated with moderately increases in HDL-c. The combination of ezetimibe with a statin helps to achieve LDL-c target in patients with unsatisfactory cholesterol lowering by statin alone. Fibrates (PPAR-α agonists) or PPAR-γ agonists reduce the levels of triglycerides and moderately elevate HDL-c. PPAR-γ agonists also improve insulin sensitivity. Cholesteryl ester transfer protein inhibitors may dramatically increase HDL-c. Lipid management has been considered as an effective approach to reduce cardiovascular risk in diabetes.

Keywords: Dyslipidemia, Diabetes, Cardiovascular complications, Lipid and lipoprotein metabolism, Pharmacological management of lipid disorders

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