Atherogenic Dyslipidaemia in Type 2 Diabetes
Dyslipidaemia is a major risk factor for atherosclerotic coronary heart disease, which in turn is the commonest cause of mortality in type 2 diabetes. This highlights the importance of appropriate management of diabetic dyslipidaemia. Management is typically multifactorial and includes dietary recommendations, routine physical exercise, aggressive control of other lifestyle risk factors, and for many patients drug intervention. Future drug treatments will increasingly target not only mechanisms that might improve glucose and LDL cholesterol blood levels, but also improve other facets of diabetic dyslipidaemia, atherogenesis and vascular risk.
Metabolic syndrome is highly prevalent in developed countries, affecting about 22% of adults in the United States. Obesity is an important risk factor for both type 2 diabetes and metabolic syndrome, and many patients with metabolic syndrome either have type 2 diabetes, or may go on to develop type 2 diabetes, making these two metabolic diseases a closely linked therapeutic challenge for clinicians.
Atherosclerotic coronary heart disease (CHD) is common in patients with diabetes or metabolic syndrome. Indeed, type 2 diabetes is now classified as a 'CHD equivalent', as the risk of a future cardiovascular event (e.g. myocardial infarction, stroke) among patients with diabetes may be similar to that of non-diabetic patients with a previous cardiovascular event. This has important clinical implications in that the lipid treatment goals in patients with CHD and those with CHD equivalents are effectively the same. The NCEP ATP III has also defined treatment recommendations for metabolic syndrome in recognition that this constellation of risk factors, which includes lipid abnormalities, confers a high risk of vascular events ( Table 1 ).
This article defines the atherogenic dyslipidaemic profile associated with type 2 diabetes and outlines some of the more promising new approaches to future drug treatment.
Dyslipidaemia is a major risk factor for atherosclerotic coronary heart disease, which in turn is the commonest cause of mortality in type 2 diabetes. This highlights the importance of appropriate management of diabetic dyslipidaemia. Management is typically multifactorial and includes dietary recommendations, routine physical exercise, aggressive control of other lifestyle risk factors, and for many patients drug intervention. Future drug treatments will increasingly target not only mechanisms that might improve glucose and LDL cholesterol blood levels, but also improve other facets of diabetic dyslipidaemia, atherogenesis and vascular risk.
Metabolic syndrome is highly prevalent in developed countries, affecting about 22% of adults in the United States. Obesity is an important risk factor for both type 2 diabetes and metabolic syndrome, and many patients with metabolic syndrome either have type 2 diabetes, or may go on to develop type 2 diabetes, making these two metabolic diseases a closely linked therapeutic challenge for clinicians.
Atherosclerotic coronary heart disease (CHD) is common in patients with diabetes or metabolic syndrome. Indeed, type 2 diabetes is now classified as a 'CHD equivalent', as the risk of a future cardiovascular event (e.g. myocardial infarction, stroke) among patients with diabetes may be similar to that of non-diabetic patients with a previous cardiovascular event. This has important clinical implications in that the lipid treatment goals in patients with CHD and those with CHD equivalents are effectively the same. The NCEP ATP III has also defined treatment recommendations for metabolic syndrome in recognition that this constellation of risk factors, which includes lipid abnormalities, confers a high risk of vascular events ( Table 1 ).
This article defines the atherogenic dyslipidaemic profile associated with type 2 diabetes and outlines some of the more promising new approaches to future drug treatment.