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Diabetes and Dyslipidemia

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Diabetes and Cardiovascular Disease

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

Atherosclerotic cardiovascular disease (ASCVD) is a major cause of morbidity and mortality in both men and women with type 1 and type 2 diabetes. There are numerous risk factors that contribute to the increased risk of ASCVD, but dyslipidemia plays a major role. In patients with type 1 diabetes in good glycemic control, the lipid profile is very similar to the lipid profile in non-diabetics. In contrast, in patients with type 2 diabetes, even with good glycemic control, lipid abnormalities are frequently observed (elevated triglycerides and non-HDL-C, decreased HDL-C, and an increase in small dense LDL). Poor glycemic control in both type 1 and type 2 diabetes increases triglyceride and non-HDL-C levels and decreases HDL-C levels with only modest effects on LDL-C levels. Numerous studies have demonstrated that statins decrease ASCVD in patients with type 2 diabetes and limited data have suggested that statins also reduce events in patients with type 1 diabetes. Treatment with high doses of potent statins reduces cardiovascular events to a greater extent than low-dose statin therapy. Adding fibrates or niacin to statin therapy has not been shown to further decrease cardiovascular events. However, there are data suggesting that fibrates may reduce ASCVD is patients with high triglyceride levels and low HDL-C levels. In contrast, recent studies have clearly shown that the combination of a statin and ezetimibe, a PCSK9 inhibitor, or EPA, an omega-3-fatty acid, does result in a greater decrease in cardiovascular events than statins alone. Current recommendations state that most patients with diabetes should be on statin therapy and in many patient’s combination therapy is indicated.

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Acknowledgements

This chapter is an updated version of a chapter in Endotext (Endotext.org) on this topic. Permission was obtained from Endotext to utilize portions of that chapter [41].

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  1. Department of Medicine, Endocrine Section, University of California-San Francisco, San Francisco, CA, USA

    Kenneth R. Feingold & Carl Grunfeld

  2. Staff for Research and Development-San Francisco VA Medical Center, San Francisco, CA, USA

    Carl Grunfeld

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Feingold, K.R., Grunfeld, C. (2023). Diabetes and Dyslipidemia. In: Johnstone, M., Veves, A. (eds) Diabetes and Cardiovascular Disease. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-031-13177-6_14

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