Comparison of Lipid-Lowering Medications and Risk for Cardiovascular Disease in Diabetes
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Purpose of the Review
To summarize available evidence regarding lipid-lowering interventions for the prevention of cardiovascular disease in patients with diabetes.
Statins and non-statin therapies that act through upregulation of LDL receptor expression are associated with similar cardiovascular risk reduction per decrease in LDL cholesterol.
In subjects with diabetes, with or without established cardiovascular disease, each 39 mg/dl reduction in LDL cholesterol observed with statins is associated with a 21% relative reduction in the risk of major coronary events at 5 years. Statins remain the first-line lipid-lowering agents for the management of dyslipidemia in individuals with diabetes; however, the addition of non-statin therapies to lower LDL cholesterol, such as ezetimibe and PCSK-9 inhibitors, to maximally tolerated statin therapy is recommended in patients with atherosclerotic cardiovascular disease and baseline LDL cholesterol over 70 mg/dl. Recent data support even lower LDL cholesterol targets (< 55 mg/dl) to further reduce the risk of cardiovascular events especially in subjects with diabetes and documented cardiovascular disease.
KeywordsDiabetes Lipid-lowering interventions Cardiovascular disease
Compliance with Ethical Standards
Conflict of Interest
Ilaria Cavallari, Alessia Delli Veneri, Rosetta Melfi, Nicola Napoli, and Germano Di Sciascio declare that they have no conflict of interest.
Ernesto Maddaloni has received speaker fees from Merck-Serono and grant support from scientific societies through AstraZeneca and Lilly.
Giuseppe Patti is a speaker/consultant/advisory board member for Amgen, AstraZeneca, Bayer, BMS-Pfizer, Boehringer Ingelheim, Daiichi Sankyo, Malesci, MSD, PIAM, Sanofi, and Sigma-Tau.
Paolo Pozzilli received research funds and consulting fees from Sanofi, Lilly, and Medtronic, AstraZeneca.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
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