Hyperlipidemia management in diabetes: First line or supportive therapy?

Diabetes Metab Syndr. 2022 Apr;16(4):102470. doi: 10.1016/j.dsx.2022.102470. Epub 2022 Mar 20.

Abstract

Background & aims: Coronary heart disease (CHD) is the most important cause of morbidity and mortality in type 2 diabetes. Current therapeutic approach has changed from glucocentric to vasculoprotective. This brief review highlights importance of management of hyperlipidemia (raised LDL cholesterol and triglycerides) on CHD outcomes in diabetes.

Methods: Literature seach was done till March 2022 (Pubmed, Google scholar) using following search words; lipids, cholesterol, statins, triglycerides, fibrates, omega-3 polyunsaturated fatty (Omega-3 PUFAs) acids, LDL, diabetes, coronary heart disease.

Results: Meta-analyses of randomized controlled trials have reported that LDL cholesterol lowering using moderate to high intensity statins significantly reduces adverse CHD outcomes in diabetes. Evidence of triglyceride reduction using fenofibrate or omega-3 PUFAs is not very robust although a trial of a purified omega-3 PUFAs has shown significant benefit.

Conclusion: Lipid lowering with statins along with comprehensive lifestyle changes in addition to glucose control is recommended as first-line therapy to reduce CHD mortality and morbidity in diabetes.

Publication types

  • Review

MeSH terms

  • Cholesterol, LDL
  • Coronary Disease*
  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / drug therapy
  • Fatty Acids, Omega-3* / therapeutic use
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
  • Hyperlipidemias* / complications
  • Hyperlipidemias* / drug therapy
  • Triglycerides

Substances

  • Cholesterol, LDL
  • Fatty Acids, Omega-3
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Triglycerides