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New treatment options for lipid-lowering therapy in subjects with type 2 diabetes

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Abstract

Dyslipidemias represent a variety of quantitative and/or qualitative lipoprotein abnormalities. According to etiology, we distinguish primary dyslipidemias with strictly genetic background and secondary ones with their origin in other disease or pathological states. Diabetic dyslipidemia is a type of secondary dyslipidemia and plays an important role in determining the cardiovascular risk of subjects with type 2 diabetes. In these patients, insulin resistance is responsible for overproduction and secretion of atherogenic very low density lipoprotein. In addition, insulin resistance promotes the production of small dense low-density lipoprotein (LDL) and reduces high-density lipoprotein (HDL) production. Cardiovascular disease remains a leading cause of morbidity and mortality in diabetic patients. Previous results support the role for small, dense LDL particles in the etiology of atherosclerosis and their association with coronary artery disease. Moreover, lowering LDL cholesterol reduces the risk of cardiovascular death. Therefore, the European guidelines for the management of dyslipidemias recommend an LDL cholesterol goal < 100 mg/dL in diabetic subjects without cardiovascular events. Moreover, if triglycerides (TG) are elevated (> 400 mg/dL), they recommend a non-HDL cholesterol goal < 130 mg/dL in diabetic individuals without cardiovascular events. Statins are the first line of LDL-lowering therapy in diabetic patients and combined therapy with ezetimibe and statins could be useful in very high cardiovascular risk diabetic subjects. Furthermore, the effect of a fibrate as an add-on treatment to a statin could improve the lipid profile in diabetic individuals with high TG and low HDL cholesterol. Regarding new therapies, recent data from phase III trials show that proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors considerably decrease LDL cholesterol. Thus, they may be useful in diabetic patients with concomitant diseases such as familial dyslipidemia, recurrent cardiovascular events, and elevated LDL cholesterol after second drug administration in addition to maximal statin dose or statin intolerance.

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Acknowledgements

We wish to thank the Scientific Bureau of the University of Catania for language support.

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This review did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy

    Roberto Scicali, Antonino Di Pino, Viviana Ferrara, Francesca Urbano, Salvatore Piro, Agata Maria Rabuazzo & Francesco Purrello

  2. Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy

    Francesco Purrello

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  1. Roberto Scicali
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  2. Antonino Di Pino
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  3. Viviana Ferrara
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  6. Agata Maria Rabuazzo
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  7. Francesco Purrello
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Correspondence to Francesco Purrello.

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Scicali, R., Di Pino, A., Ferrara, V. et al. New treatment options for lipid-lowering therapy in subjects with type 2 diabetes. Acta Diabetol 55, 209–218 (2018). https://doi.org/10.1007/s00592-017-1089-4

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