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Mechanisms and Treatment of Dyslipidemia in Diabetes

Current Cardiology Reports volume 23, Article number: 26 (2021) Cite this article

Abstract

Purpose of Review

Type 2 diabetes mellitus is widespread throughout the world and is a powerful risk factor for the development of atherosclerotic cardiovascular disease (ASCVD). This manuscript explored the mechanisms underlying dyslipidemia in type 2 diabetes as well as currently available treatment options and guideline recommendations.

Recent Findings

Type 2 diabetes is associated with a characteristic pattern of dyslipidemia, often termed diabetic dyslipidemia. Patients with type 2 diabetes often present with low HDL levels, elevated levels of small dense LDL particles, and elevated triglyceride levels. LDL lowering is the cornerstone of managing diabetic dyslipidemia, and statins are the mainstay of therapy. The cholesterol absorption inhibitor ezetimibe and PCSK9 inhibitors have also been shown to lower risk in patients with diabetes. Recently, the eicosapentaenoic (EPA) only n-3 fatty acid, icosapent ethyl, has also shown benefit for cardiovascular risk reduction in patients with diabetes. To date, no agents targeting HDL increase have shown cardiovascular benefit in patients on background statin therapy.

Summary

Diabetic dyslipidemia is significant cardiovascular disease risk factor, and LDL-lowering therapy with statins, PCSK9 inhibitors, and ezetimibe continues to be mainstay therapy to reduce cardiovascular risk. Future studies targeting low HDL and high triglycerides levels associated with type 2 diabetes could provide additional novel therapies to manage diabetic dyslipidemia.

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Authors and Affiliations

  1. Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Ehete Bahiru, Ruth Hsiao, Daniel Phillipson & Karol E. Watson

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Bahiru, E., Hsiao, R., Phillipson, D. et al. Mechanisms and Treatment of Dyslipidemia in Diabetes. Curr Cardiol Rep 23, 26 (2021). https://doi.org/10.1007/s11886-021-01455-w

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