TY - JOUR
T1 - Treatment of diabetic dyslipidemia
AU - Garg, Abhimanyu
N1 - Funding Information:
Supported in part by the Department of Veterans Affairs, by grants (HL-29252, M01-RR00633) from the National Institutes of Health, by the Southwestern Medical Foundation, and by the Moss Heart Foundation of Dallas, Texas.
PY - 1998/2/26
Y1 - 1998/2/26
N2 - Patients with diabetes mellitus have an increased risk for coronary artery disease due to hyperglycemia, hypertension, dyslipidemia, and other risk factors. The diabetic dyslipidemia in these patients is characterized by moderately high levels of (1) serum cholesterol and triglycerides; (2) small, dense low-density lipoprotein (LDL) particles and (3) low high-density lipoprotein (HDL) cholesterol concentrations. Recent clinical trials have demonstrated the benefits of cholesterol-lowering therapy in both diabetic and nondiabetic patients, thus supporting aggressive treatment of diabetic dyslipidemia for coronary artery disease prevention. A 3-step approach is recommended for the treatment of diabetic dyslipidemia. First, modification of diet and lifestyle, including decreased intakes of cholesterol, cholesterol-raising fats, and total energy, and increased physical activity should be advised. Second, good glycemic control should be achieved with diet and hypoglycemic drugs, if needed. Third, lipid-lowering drugs should be used, if necessary. Non-HDL cholesterol levels, which include both very-low- density lipoprotein (VLDL) and LDL cholesterol, should be the target of cholesterol-lowering therapy. The use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (the 'statins') has became the first-line drug therapy for diabetic dyslipidemia. Bile acid sequestrants are effective cholesterol- lowering agents in nor-motriglyceridemic patients with non-insulin-dependent diabetes mellitus (NIDDM). Patients with severe hyper-triglyceridemia may require fibric acids or n-3 polyun-saturated fatty acids. Nicotinic acid worsens hyperglycemia; therefore, if should be avoided in most cases. The efficacy and safety of estrogen-replacement therapy in postmenopausal women with diabetes needs to be determined. The combination of two lipid-lowering agents may be appropriate for same NIDDM patients but should be used judiciously.
AB - Patients with diabetes mellitus have an increased risk for coronary artery disease due to hyperglycemia, hypertension, dyslipidemia, and other risk factors. The diabetic dyslipidemia in these patients is characterized by moderately high levels of (1) serum cholesterol and triglycerides; (2) small, dense low-density lipoprotein (LDL) particles and (3) low high-density lipoprotein (HDL) cholesterol concentrations. Recent clinical trials have demonstrated the benefits of cholesterol-lowering therapy in both diabetic and nondiabetic patients, thus supporting aggressive treatment of diabetic dyslipidemia for coronary artery disease prevention. A 3-step approach is recommended for the treatment of diabetic dyslipidemia. First, modification of diet and lifestyle, including decreased intakes of cholesterol, cholesterol-raising fats, and total energy, and increased physical activity should be advised. Second, good glycemic control should be achieved with diet and hypoglycemic drugs, if needed. Third, lipid-lowering drugs should be used, if necessary. Non-HDL cholesterol levels, which include both very-low- density lipoprotein (VLDL) and LDL cholesterol, should be the target of cholesterol-lowering therapy. The use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (the 'statins') has became the first-line drug therapy for diabetic dyslipidemia. Bile acid sequestrants are effective cholesterol- lowering agents in nor-motriglyceridemic patients with non-insulin-dependent diabetes mellitus (NIDDM). Patients with severe hyper-triglyceridemia may require fibric acids or n-3 polyun-saturated fatty acids. Nicotinic acid worsens hyperglycemia; therefore, if should be avoided in most cases. The efficacy and safety of estrogen-replacement therapy in postmenopausal women with diabetes needs to be determined. The combination of two lipid-lowering agents may be appropriate for same NIDDM patients but should be used judiciously.
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U2 - 10.1016/S0002-9149(98)00038-1
DO - 10.1016/S0002-9149(98)00038-1
M3 - Article
C2 - 9526814
AN - SCOPUS:0032567918
SN - 0002-9149
VL - 81
SP - 47B-51B
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 4 A
ER -