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Epidemiology, Control, and Cardiovascular Outcomes of Dyslipidemia in Diabetes

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Lipoproteins in Diabetes Mellitus

Part of the book series: Contemporary Diabetes ((CDI))

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Abstract

Persons with diabetes mellitus have excess mortality from atherosclerotic cardiovascular disease (ASCVD). Dyslipidemia is among the key risk factors for ASCVD and in persons with diabetes typically is characterized by elevated triglycerides, low levels of high-density lipoprotein cholesterol (HDL-C), and/or moderate levels of low-density lipoprotein cholesterol (LDL-C), along with a greater prevalence of atherogenic small dense LDL particles. In the United States, it is estimated that 35–50% of patients with T2DM have dyslipidemia, characterized by triglycerides ≥150 mg/dL, HDL-C <40 mg/dL in men or <50 mg/dL in women, and/or LDL-C ≥100 mg/dL, with two or all three of these common in those with DM. There are, however, significant disparities in dyslipidemia prevalence and/or its treatment between women and men and across race/ethnicity both within the United States and globally. Key epidemiologic studies and clinical trials have demonstrated a direct relation of elevated triglycerides and LDL-C with future ASCVD event risk, with an inverse association of HDL-C with ASCVD event risk, including in persons both with and without diabetes. Moreover, LDL-C reduction has the most significant impact of all major cardiovascular risk factors in reducing the risk of future ASCVD events in persons with diabetes. Clinical trial evidence from trials on statins, ezetimibe, and PCSK9 inhibitors demonstrates the value of pharmacologic reduction of LDL-C to be at least as great, if not greater in those with diabetes, given their higher absolute baseline risk. An important challenge remains to improve treatment and control of dyslipidemia in persons with diabetes to reduce their cardiovascular risk.

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Authors and Affiliations

  1. Heart Disease Prevention Program, C240 Medical Sciences, University of California, Irvine, CA, USA

    Wenjun Fan & Nathan D. Wong

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  1. Wenjun Fan
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  2. Nathan D. Wong
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Correspondence to Nathan D. Wong .

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  1. NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia

    Alicia J. Jenkins

  2. Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Peter P. Toth

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Fan, W., Wong, N.D. (2023). Epidemiology, Control, and Cardiovascular Outcomes of Dyslipidemia in Diabetes. In: Jenkins, A.J., Toth, P.P. (eds) Lipoproteins in Diabetes Mellitus. Contemporary Diabetes. Humana, Cham. https://doi.org/10.1007/978-3-031-26681-2_32

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